John Maltby_ et al - Research methods for nursing and healthcare-Pearson Education (2010)

Chapter 13 Going forward: A step-by-step guide from research idea to ethics application

Example 13.1 continued

Phase 2: postal questionnaires Comment [p9]: Possible
By extracting the main factors of complementary therapy use from ethical concerns arise – do
the focus group data and with a comprehensive literature review, we will participants get a chance to
develop, pilot and distribute a questionnaire. This phase will enable us take away the questionnaire
to explore how prevalent such factors have been among a sample of and consider whether they
200 complementary therapy users within East Staffordshire. Our con- want to take part or is there
venience sample will be drawn from a wide range of users (health profes- a possibility that they might
sionals and lay persons) with whom the research team comes into be pressurised into taking
contact in the course of our work. Questionnaires will be handed out and part? Would it be appropri-
administered face-to-face. Users will be offered the opportunity to be en- ate to get the team handing
tered into a prize draw if they return a completed questionnaire. Com- it out to their patients when
pleted questionnaires will be entered onto a statistical computer package conflicts in role as health
(SPSS) and a range of descriptive analyses will be carried out. Phase 2 professional and researcher
should take about 4 months. may arise? Might it be best
to get an independent per-
Phase 3: interviews son to collect the data, espe-
This phase will involve approaching a sample of 30 participants from cially if some of the
the questionnaire respondents who expressed an interest in being inter- participants may be saying
viewed: 15 of the participants will be health professionals and the other less than complimentary
15 will be lay members without a health professional background. things about the services
These participants will be invited to an interview by one of the research that they receive from GP
team. The interviews will be semi-structured and will enable us to surgeries?
adopt a deeper analysis of themes that may not be amenable to discus-
sion in a group setting. We will audiotape the interviews and carry out Comment [p10]: Again,
verbatim transcription of the conversations. We will then thematically this rationale of splitting
analyse the interview data and see how these trends complement find- them up into two groups
ings from Phases 1 and 2. hasn’t been made clear.

Phase 4: presentation/open forum
We will be staging a presentation of some of the key trends to about 50
invited key stakeholders within East Staffordshire who are involved in
the commissioning, provision and receipt of CAM in primary care. This
phase will provide us with the opportunity to disseminate results but also
to obtain a wide range of perspectives regarding our findings. Comments
from the open forum will be incorporated into the final report to be sub-
mitted to East Staffordshire PCT and in presentations to other PCTs
within the West Midlands region.

References
Adewuyi-Dalton, R. and Walker, G. (1999, March) A qualitative investiga-

tion of users’ experiences of group relaxation classes and aromatherapy
massage in a cancer support and information centre. Mount Vernon
Hospital: Internal Report.

Adler, S.R. (1999) Complementary and alternative medicine use among
women with breast cancer. Medical Anthropology Quarterly, 13 (2),
214–222.

Cawthorn, A. (1995) A review of the literature surrounding the research
into aromatherapy. Complementary Therapy, Nursing and Midwifery, 1
(4), 118–120.

Ernst, E. (1998) Complementary therapies for asthma: what patients
use. Journal of Asthma, 35 (8), 667–671.

334

Developing your research proposal

Example 13.1 continued

Rankin-Box, D. (1997) Therapies in practice: a survey of assessing Comment [p11]: As
nurses’ use of complementary therapies. Complementary Therapy, mentioned earlier in the
Nursing and Midwifery, 3 (4), 92–99. comments on this proposal,
it might be better to have a
Royal London Homeopathic Hospital (1999) The Evidence-base of Comple- survey of some users of
mentary Medicine, 2nd edn. London: The Royal London Homeopathic CAM outside of the local
Hospital. region too in order to find
out how generalisable these
Wearn, A.M. and Greenfield, S.M. (1998) Access to complementary findings are
medicine in general practice: survey in one UK health authority.
Journal of the Royal Society of Medicine, 91 (9), 465–470.

4. APPLICATION OF STUDY RESULTS

Please detail generalisability and relevance of proposed study along with
plan for dissemination of the results and implications for health care.

Transferability
Although the study has a large qualitative component, the methods of
our study and our analysis strategies could be transferable to other stud-
ies and other settings. We will adhere to a rigorous process of conduct-
ing and analysing the interviews and focus groups (i.e. using several
people for classifying data into themes and checking with interviewees
to ensure that the themes agree with their interpretation of the data).
The issues raised and the processes of discovering underlying beliefs
and practices may be transferable to a mixture of ethnic groups as our
sample will attempt to reflect the diversity of ethnicities within the area.
Prevalence data from the questionnaire survey should also allow us to
analyse the extent to which our sample is comparable with samples ob-
tained in other studies into complementary therapy use.

Relevance
The project outcomes could affect the attitudes and practices of a wide
range of stakeholders involved in primary care and the provision or re-
ceipt of CAM. GPs, users, commissioners, providers of ‘conventional’
health services and providers of CAM may all be affected in a number of
different ways.

With the recent changes in the way that primary care services will be
commissioned by PCTs and the increased awareness about CAM among
users and practitioners, it will be important to ensure that the findings
of our research are at the forefront of primary care commissioning.

We are anticipating that our study could be influential in:

• Commissioning and marketing complementary therapy in primary
care settings;

• Highlighting the health beliefs and practices of lay and health profes-
sional users of CAM;

• Identifying barriers to accessing appropriate health care (complemen-
tary or otherwise).

Dissemination
We will be looking to disseminate the findings at a wide range of fo-
rums and conferences. We will be staging a presentation/open forum of
key findings to key stakeholders for discussion and action, and this will
also act as part of the dissemination process. We will also be submitting
our work to a number of peer-reviewed academic and applied journals.

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Chapter 13 Going forward: A step-by-step guide from research idea to ethics application

Third, in producing a clear proposal you will also need to consider your
timescales (the project begins at the thinking stage so ensure that you build in the
time for all of the administration, for example ethical approval). One method that
may help you to think about the project and plan time is a Gantt chart. Gantt charts
provide useful tools for planning and timetabling projects. The role of a Gantt chart
is to keep the research project on target in terms of timescales and help to sched-
ule the various component parts of a project in a sequential manner, for example,
you will need to receive ethical approval before you can recruit study participants.
Importantly, Gantt charts also enable you to identify the ‘critical path’ of the proj-
ect, that is the sequence in which tasks will need to be completed at a particular
point in time in order for the project to be successfully completed by the project
end date.

There are a number of ways of producing a Gantt chart and we have included two ex-
amples below. Gantt charts can be produced in Microsoft Excel for example and there
are also a number of computer-assisted software packages available – depending on
the size and complexity of the project. Figures 13.1 and 13.2 illustrate two examples of
Gantt charts that have been used with a professional project management computer
program. In Figure 13.1 you can see that the duration of each task is indicated with a
shaded box. Some tasks have what are known as ‘milestones’, these are specific dates
by which certain activities need to be done. By 23 October, activity Number 13 needs to
be achieved and there are several other activities that have deadlines, like activity
Number 32 (the production of the final report), which needs to be done by 4 July. The
last couple of activities (Numbers 35 and 36) involve telling others about the research
findings.

In Figure 13.2, this is an example of a study that has the use of two major types
of methods – analysis of data that have already been collected (see activities num-
bered 14-33) and the running of two sets of focus group interviews (see activities
numbered 10-13 and 35-39) with the first set of focus groups informing the analy-
sis of currently existing quantitative data and the second set of focus groups act-
ing as a resource to get stakeholders to comment on the quantitative data
analysis, in a way similar to the conducting of Delphi studies that we mentioned
in the previous chapter. In this way, the informants or stakeholders in the first
round of focus groups are helping to set the agenda and posing certain research
questions whilst the second round of focus groups acts as a forum for the stake-
holders to critique the validity and usefulness of the quantitative data that have
been analysed.

13.5 Ethical considerations

As a general rule, quite a few proposed studies with patients/service users often
require ethical approval from a local Research Ethics Committee (REC) before the re-
search can be carried out. Some studies, like systematic reviews of data in a publicly

336

ID Task Name 2007
1 Recruit research fellow Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep
2 Update BHPS authorisation
3 Purchase software 23/10
4 Additional reading 04/12
5 Initial data management
6 Specification of material deprivation index 2003 22/03
7 Specification of stress index 2003
8 Specification of CPI 2003 07/06
9 Examine component consistency of CPI 2003 04/07
10 Examine socio-demographic correlates with CPI 2003, descriptive 11/07
11 Examine socio-demographic correlates with CPI 2003, modelling
12 Writing working paper
13 Working Paper on CPI 2003 rates and comparisons
14 Examine change in CPI 2003 rate over time
15 Examine change in CPI 2003 constituents over time
16 Writing working paper
17 Working Paper on trends in CPI 2003 rate
18 Specification of material deprivation index 1991
19 Specification of stress index 1991
20 Specification of CPI 1991
21 Examine component consistency of CPI 1991
22 Examine socio-demographic correlates with CPI 1991, descriptive
23 Examine socio-demographic correlates with CPI 1991, modelling
24 Examine change in CPI 1991 rate over time
25 Examine change in CPI 1991 constituents over time
26 Write working paper
27 Working paper comparing CPI 1991 and CPI 2003
28 Lagged analysis of CPI components
29 Writing working paper
30 Working paper on explanatory analyses
31 Writing final report
32 Final report
33 Writing short synthesis report
34 Synthesis report
35 Set up dissemination events
36 Dissemination events

Project Without Task Progress Summary Rolled Up Split Rolled Up Progress Project Summary
Date: Wed 18/05/05 Split Milestone Rolled Up Task Rolled Up Milestone External Tasks

Page 1

337 Figure 13.1 A Gantt chart for a study mainly involving data analysis.

338 ID Task Name 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter 1st Quarter Mar
1 Recruit research fellow Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb
2 Update BHPS authorisation
3 Purchase software 10/01
4 Additional reading 21/02
5 Initial data management
6 Liaise with UKCAP 06/09
7 Negotiate with local UKCAP affiliates 07/09
8 Recruitment of groups
9 Design instrumentation
10 Conduct 1st wave groups
11 Transcription
12 Analyse 1st wave groups
13 Write up of 1st wave groups
14 Specification of material deprivation index 2003
15 Specification of stress index 2003
16 Specification of CPI 2003
17 Examine component consistency of CPI 2003
18 Examine socio-demographic correlates with CPI 2003, descriptive
19 Examine socio-demographic correlates with CPI 2003, modelling
20 Writing working paper
21 Working Paper on CPI 2003 rates and comparisons
22 Examine change in CPI 2003 rate over time
23 Examine change in CPI 2003 constituents over time
24 Writing working paper
25 Working Paper on trends in CPI 2003 rate
26 Specification of material deprivation index 1991
27 Specification of stress index 1991
28 Specification of CPI 1991
29 Examine component consistency of CPI 1991
30 Examine socio-demographic correlates with CPI 1991, descriptive
31 Examine socio-demographic correlates with CPI 1991, modelling
32 Examine change in CPI 1991 rate over time
33 Examine change in CPI 1991 constituents over time
34 Writing final draft JRF report
35 Recruitment of 2nd wave groups
36 Design instrumentation for 2nd groups
37 Conduct 2nd wave groups
38 Transcription
39 Analyse 2nd wave groups
40 Revise final JRF report
41 Final JRF Report
42 Writing JRF findings
43 JRF findings
44 Set up dissemination events
45 Dissemination events

Project: AL Ttim Task Progress Summary Rolled Up Split Rolled Up Progress Project Summary
Date: Wed 15/12/04 Split Milestone Rolled Up Task Rolled Up Milestone External Tasks

Page 1

Figure 13.2 A Gantt chart for a mixed methods study.

Ethical considerations

accessible archive, will usually not require ethical approval and other pieces of work
could be reasonably defined as clinical audit or service evaluation. If your proposed
work is either clinical audit or evaluation, then ethical approval should not be sought
either. The National Research Ethics Service (NRES) is part of the National Patient
Safety Agency (NPSA) and provides helpful guidance on its website: http://
www.nres.npsa.nhs.uk/. This guidance can help you decide if your project can be
suitably defined as research, or audit, or service evaluation.

THINGS TO CONSIDER

Is it research, audit or evaluation?

The NRES (2008) has published a document outlining the decisions to be made
before approaching a local REC. If clinicians are carrying out activities of quality
assurance such as clinical audit or assessing whether a service meets a specific
standard, then ethical approval is not needed. However, as the NRES (2008) high-
lights, research may involve greater risks to patient well-being and satisfactory
practice. To help decide whether your work is research, audit or evaluation, con-
sider the following four issues: (1) intent, (2) treatment, (3) allocation of treatments,
and (4) randomisation.

With intent, by its very nature, research might be testing or developing new
knowledge and this could mean putting patients in a novel, and possibly uncomfort-
able, position beyond the usual care that they might receive. By the definition of re-
search that the NRES is adopting, research is often aimed at finding out what
should be done, whereas audit and evaluation should be intended to track what is
being done.

With assessment of treatment/care techniques, audit and service evaluation will
only involve analysing treatment that has a satisfactory evidence-base to support it;
by contrast, research may involve developing this evidence-base and trialling new
treatments.

In terms of allocation of patients into intervention groups to receive a specific
treatment, this is mainly likely to happen with research and to follow a protocol of al-
locating participants into control groups or intervention/treatment groups. Con-
versely, audit and evaluation will only be analysing care that has been agreed upon
between health professional and patient.

Finally, randomisation is another means of differentiating research from audit/
evaluation. In research, patients might sometimes be randomly assigned to groups
that are studied, whereas audit and evaluation should not have any persons being
randomly allocated to various treatment or control groups.

The NRES can also point you in the direction of your local REC by identifying the dif-
ferent RECs available by Strategic Health Authority and by country (England, Wales,
Scotland and Northern Ireland). Another thing to bear in mind is that the criteria

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Chapter 13 Going forward: A step-by-step guide from research idea to ethics application

that local RECs will use to assess the acceptability of an ethics application might
vary by the type of study that is being proposed. For instance, there are only certain
RECs that can review applications made to do a Clinical Trial of an Investigational
Medical Product (or CTIMP, for short). There are other criteria to be borne in mind
if your research includes prisoners, children, adults who might not have the
mental capacity to give consent to take part in research, medical devices, or ionising
radiation.

From 1 April 2009, it has been a requirement for all new applications to National
Health Service (NHS) RECs to be made through the online Integrated Research
Application System (IRAS). This is available from the website: https://www.
myresearchproject.org.uk/ Likewise, all applications for an NHS Trust’s R&D depart-
ment to support a research study also need to be submitted via IRAS. The IRAS is a
very handy system as it standardises the forms that you need to fill out, irrespective
of which local REC you apply to. There are different forms that are available from
IRAS for applying to do clinical trials, clinical investigations of medical devices and
studies involving ionising radiation. The types of forms that will probably be more of
interest to many of you are the ones dealing with questionnaires/interviews for
quantitative analysis or mixed quantitative/qualitative methodology. There is also a
specific form for those who wish only to use qualitative methods and there is
another form for those who are doing a student project (not for a doctorate but for
other levels of qualification). For non-doctoral students to do a project involving
NHS patients/service users, this will require the chief investigator (usually the stu-
dent’s supervisor) to fill out most sections of the form in conjunction with the stu-
dent. At present, a student who is doing research for a doctorate is expected to be
the chief investigator and largely responsible for maintaining appropriate ethical
standards throughout the study.

IRAS provides some example application forms to give applicants an idea of the
questions that are being asked, depending on the type of study that is being pro-
posed. You will need to give yourself sufficient time to draft your application and get
feedback from colleagues or your supervisor before you complete your application
online. You will also need to consider the underpinning ethical principles that guide
the decision-making of ethical committees and which help to inform your decisions,
as a researcher, while the study is underway. To get an idea of the kinds of questions
that need to be answered, we have provided you with excerpts of the online ethics
form in Example 13.2. Please note that we have drafted these excerpts to illustrate
the issues that are being considered by the local REC and there are some sections
that have not been completed in this example. Usually, all sections need to be filled
out. It is also worth noting that the ethics form is a relatively lengthy document, but
do not let this deter you; this is because there needs to be a range of safeguards to
protect the people who are taking part in your research and the welfare of partici-
pants (and researchers!) should always be borne in mind. We will revisit the ethics
form in Example 13.2 when discussing the four main ethical principles for conducting
acceptable research.

340

Ethical considerations

Example 13.2 Research Ethics Committee applications using the
Integrated Research Application System (IRAS) form

[Note to reader: Below is a draft of an ethics application for a study using the applica-
tion form template entitled, ‘Questionnaires/interviews for quantitative analysis or
mixed quantitative/qualitative methodology – including children’.

Only some of these sections are completed, for illustrative purposes. Please note that
the sections in the forms do not follow a wholly sequential order, as some of the sec-
tions are only included in forms for certain types of studies].

Please enter a short title for this project (maximum 70 characters)
Acceptability of Pupil-Held Record to Students, Parents and Health Professionals

1. Is your project an audit or service evaluation?

° Yes • No

2a. Select one category from the list below:

° Clinical trial of an investigational medicinal product
° Clinical investigation or other study of a medical device
° Combined trial of an investigational medicinal product and an investigational

medical device

° Other clinical trial or clinical investigation

• Study administering questionnaires/interviews for quantitative analysis, or
using mixed quantitative/qualitative methodology

° Study involving qualitative methods only
° Study limited to working with human tissue samples, other human biological

samples and/or data (specific project only)

° Research tissue bank
° Research database

If your work does not fit any of these categories, select the option below:

° Other study

2b. Please answer the following question(s):

(a) Does the study involve the use of any ionising radiation?

° Yes • No

(b) Will you be taking new human tissue samples (or other human biological

samples)?

° Yes • No

(c) Will you be using existing human tissue samples (or other human biological

samples)?

° Yes • No

3. In which countries of the UK will the research sites be located? (Tick all that apply)
• England

° Scotland

▲

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Chapter 13 Going forward: A step-by-step guide from research idea to ethics application

Example 13.2 continued

° Wales
° Northern Ireland

4. In completing this form, which bodies are you making an application to?

• NHS/HSC Research and Development offices

• Research Ethics Committee

° Patient Information Advisory Group (PIAG)
° Ministry of Justice (MoJ)

5. Will any research sites in this study be NHS organisations?

• Yes ° No

6. Do you plan to include any participants who are children?

• Yes ° No

7. Do you plan to include any participants who are adults unable to consent for

themselves through physical or mental incapacity? The guidance notes explain how

an adult is defined for this purpose.

° Yes • No

8. Do you plan to include any participants who are prisoners or young offenders

in the custody of HM Prison Service in England or Wales?

° Yes • No

9. Is the study, or any part of the study, being undertaken as an educational

project?

° Yes • No

10. Will identifiable patient data be accessed outside the clinical care team

without prior consent at any stage of the project (including identification of

potential participants)?

° Yes • No

PART A: Core study information

1. ADMINISTRATIVE DETAILS

A1. Full title of the research:
How Acceptable Is a Pupil-Held Record (‘Health Fax’) to Students, Parents and Health
Professionals?

A2. Chief Investigator: Mr Graham A. Parker
Title Forename/Initials Surname
Post:
Qualifications: Professional Lead for School Nursing

RGN, RSN

342

Ethical considerations

Example 13.2 continued

Employer: East Staffordshire Primary Care Trust

Work Address: East Staffordshire Primary Care Trust,
Riddlestone, Greyhawkings,

Post Code: ST96 7GH

Work E-mail: [email protected]

* Personal E-mail:

Work Telephone: (017565) 862 4558

* Personal Telephone/Mobile:

Fax: (017565) 962 4548

* This information is optional. It will not be placed in the public domain or disclosed to
any other third party without prior consent.

A copy of a current CV (maximum 2 pages of A4) for the Chief Investigator must be
submitted with the application.

[Note to reader: Sections A5-1 and A5-2 cover research reference numbers and whether
the current application is connected to previous applications].

2. OVERVIEW OF THE RESEARCH
To provide all the information required by review bodies and research information systems,
we ask a number of specific questions. This section invites you to give an overview using lan-
guage comprehensible to lay reviewers and members of the public. Please read the guidance
notes for advice on this section.

[Note to reader: Sections on Lay Summary and Summary of the Main Issues precede
Section A10 onwards.]

A10. What is the principal research question/objective? Please put this in language
comprehensible to a lay person.

The principal objective of this project will be to:
• Examine the acceptability of a pupil-held record (the ‘Health Fax’) for 11-year-old

children in mainstream schools and for ‘looked after’ children aged 7 years.

A11. What are the secondary research questions/objectives if applicable? Please
put this in language comprehensible to a lay person.

The secondary objectives of this project will be to:

• Assess how the Health Fax is being used by a sample of East Staffordshire school-
children.

• Analyse the perceived usefulness of the Health Fax and make amendments to the
format and content of the Health Fax in light of comments made by pupils, parents
and health professionals (General Practitioners and School Nurses).

▲

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Chapter 13 Going forward: A step-by-step guide from research idea to ethics application

Example 13.2 continued

A12. What is the scientific justification for the research? Please put this in language
comprehensible to a lay person.

The Health Fax is an innovative health record booklet for schoolchildren, which was
originally developed by School Nurses in Optimum Health NHS Trust (McAleer and
Jackson, 1994). It was piloted in 1993 by Optimum Health with 17 schools in Lewisham
and Southwark (North). The rationale of the Health Fax was to provide the School
Nurse and the pupil with a framework for discussion about the pupil’s health needs
during the one-to-one health interview, which was usually conducted at Year 7 for
children (at age 11) in mainstream schools. The Health Fax was primarily aimed to
empower schoolchildren and to encourage them to take a shared responsibility for
their health. The Health Fax was also seen by School Nurses at Optimum as providing
the potential for enhancing communication between different agencies that may come
into contact with the child and may have similar beneficial effects as the Personal
Child Health Record in Health Visiting (McAleer and Jackson, 1994). The ethos of the
Health Fax has been supportive of policies such as the Department for Education and
Skills and Department of Health (1996)’s circular on ‘Supporting Children’ and the
Children’s Charter, as set out by the United Nations’ (1992) Convention on the Rights
of the Child. The Health Fax was seen as incorporating the recommendations of the
Polnay Report (British Paediatric Association, 1995) in which the following topics,
among others, were recommended as part of a core programme for 11–12-year-olds,
many of which are included in the Health Fax: (1) adjustment to school, (2) road
safety, (3) water safety, (4) diet, (5) smoking, (6) exercise, (7) personal hygiene,
(8) dental health, (9) sun protection, (10) sexual health and education, (11) drugs,
(12) alcohol, (13) stress, and (14) referring oneself to a School Nurse or GP. The
Health Fax was also seen as following the basic principles of health policies such as
the Hall Report (e.g. Hall and Elliman, 2006), which recommended moving away
from blanket screening to a more targeted approach by setting clear objectives and
measurable outcomes. East Staffordshire PCT’s Child Health Promotion Group has
considered adopting the Health Fax as standard practice, with the permission of the
Health Fax developers, but the PCT is as yet unclear about the benefits or difficulties
that might be encountered in using it. The Health Fax will be given out to a pilot sam-
ple of 11-year-olds in mainstream schools and to children looked after. In this study,
we are seeking to find out how the pupils in the pilot areas have experienced using the
Health Fax and what parents and health professionals also think about it.

References:

British Paediatric Association (1995) Report of a Joint Working Party on Health Needs of
School Age Children. Chaired by Leon Polnay. London: British Paediatric Association.

Department for Education and Skills and Department of Health (1996) Supporting
Pupils with Medical Needs: A good practice guide. London: DfES.

Hall, D.M. and Elliman, D. (2006) Health for all Children. Revised 4th edn. Oxford:
Oxford University Press.

McAleer, M. and Jackson, P. (1994) The school health fax. Nursing Times, 90 (31), 29–31.
United Nations (1992) Convention on the Rights of the Child. Available via: http://

www.everychildmatters.gov.uk/_files/589DD6D3A29C929ACB148DB3F13B01E7.
pdf, accessed 5 August 2009.

344

Ethical considerations

Example 13.2 continued

[Note to reader: After Section A12, Section A13 then requests a full summary of the
methodology and design of the study.]

A14–1. In which aspects of the research process have you actively involved, or
will you involve, patients, service users, or members of the public?

° Design of the research
° Management of the research
° Undertaking the research

• Analysis of results
• Dissemination of findings

° None of the above

Give details of involvement, or if none please justify the absence of involvement.

4. RISKS AND ETHICAL ISSUES

RESEARCH PARTICIPANTS

A17. Please list the principal inclusion and exclusion criteria.

Inclusion criteria:
Pupils will need to have had some experience in using the Health Fax so that they
can talk about how it may have helped, or hindered, their ability to have health- and
well-being-related dialogue with health professionals, parents or guardians. The
experience of using the Health Fax should be for at least the duration of the trial
period of 3 months.
Parents/guardians and other health professionals (e.g. General Practitioners) will need
to have come into contact with at least one pupil who has used the Health Fax during
the trial period.

Exclusion criteria:
As being able to assess the utility of the Health Fax is the primary concern of this study
and the questions in the survey only relate to the Health Fax, we will only be looking to
get feedback from people who have come into contact with using the Health Fax, either
as a pupil or responsible adult.

RESEARCH PROCEDURES, RISKS AND BENEFITS
Sections A18–A26 cover the following questions:

A18. Give details of all non-clinical intervention(s) or procedure(s) that will be
received by participants as part of the research protocol. These include seeking
consent, interviews, non-clinical observations and use of questionnaires.

1 survey.

A21. How long do you expect each participant to be in the study in total?

The survey should take about 20 minutes to complete.

▲

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Chapter 13 Going forward: A step-by-step guide from research idea to ethics application

Example 13.2 continued

A22. What are the potential risks and burdens for research participants and how
will you minimise them?

For all studies, describe any potential adverse effects, pain, discomfort, distress, intrusion,
inconvenience or changes to lifestyle. Only describe risks or burdens that could occur as a
result of participation in the research. Say what steps would be taken to minimise risks and
burdens as far as possible.

No major risk and burdens are anticipated for the participants. We do not expect there
to be a significant amount of intrusion, inconvenience or change to lifestyle as a result
of taking part.

A23. Will interviews/questionnaires or group discussions include topics that
might be sensitive, embarrassing or upsetting, or is it possible that criminal or
other disclosures requiring action could occur during the study?

° Yes • No

If Yes, please give details of procedures in place to deal with these issues:

A24. What is the potential for benefit to research participants?

Through this research, we will be able to gauge the utility of certain sections of
the Health Fax among this pilot sample of schoolchildren. We will also be able to
assess how the Health Fax might help, or hinder, effective health- and well-being-
related communication between the pupils and health professionals/parents/
guardians.

A26. What are the potential risks for the researchers themselves? (if any)
No major potential risks are anticipated.

RECRUITMENT AND INFORMED CONSENT

In this section we ask you to describe the recruitment procedures for the study. Please give
separate details for different study groups where appropriate.

A27–1. How, and by whom, will potential participants, records or samples be
identified?

See response to A29.

A28. Will any participants be recruited by publicity through posters, leaflets,
adverts or websites?

• Yes ° No

If Yes, please give details of how and where publicity will be conducted, and enclose copy of
all advertising material (with version numbers and dates).

A29. How, and by whom, will potential participants first be approached?

Students will be approached in class by the school nurse who will hand questionnaires
to everyone in class. At the same time, a questionnaire for parents/guardians will also
be given to the students to hand to their parents/guardians. For approaching children

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Ethical considerations

Example 13.2 continued

looked after who will have used the Health Fax, this will be done through liaising with
the appropriate health and social care professionals who will circulate the survey to
those children who have used the Health Fax. A sample of General Practitioners (GPs)
in the locality will be randomly selected from a list of GPs in the area and they will be
mailed a copy of the survey.

A30–1. Will you obtain informed consent from or on behalf of research
participants?

• Yes ° No

If you will be obtaining consent from adult participants, please give details of who will take

consent and how it will be done, with details of any steps to provide information (a written

information sheet, videos, or interactive material).

Arrangements for adults unable to consent for themselves should be described separately in
Part B Section 6, and for children in Part B Section 7.

If you plan to seek informed consent from vulnerable groups, say how you will ensure that
consent is voluntary and fully informed.

If you are not obtaining consent, please explain why not.

Please enclose a copy of the information sheet(s) and consent form(s).

A30–2. Will you record informed consent (or advice from consultees) in writing?

• Yes ° No

If No, how will it be recorded?

A31. How long will you allow potential participants to decide whether or not to
take part?

The participants can decide to take part during any time within the two-month study
period, after having received a copy of the questionnaire in the class or by mail.

A33–1. What arrangements have been made for persons who might not
adequately understand verbal explanations or written information given in
English, or who have special communication needs?(e.g. translation, use of
interpreters)

If appropriate in some schools, questionnaires will be translated into the pupil’s
native language and back-translated into English, to check whether there is sufficient
conceptual and functional equivalence. We will be using the local interpreting services
for this purpose.

[Note to reader: After Section A33-1 in the IRAS form there are several further
sections. These sections include questions on: confidentiality of data, storage of data,
incentives and payments, publication and dissemination of findings, scientific and
statistical review of the proposal, management of the research, insurance/indemnity
to carry out the research and considerations relating to the inclusion of children in
research.]

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Chapter 13 Going forward: A step-by-step guide from research idea to ethics application

Four ethical issues to consider

Four main moral principles (based on Beauchamp and Childress, 2001) underpin bio-
medical research as reflected in the Declaration of Helsinki (WMA, 2000) and you will
need to consider these guiding principles when you are constructing your research
study and putting together your research proposal. We have listed these principles
below, providing examples of how they are applied within practice so that you can
consider them within the context of your own developing research.

Autonomy

All researchers are required to respect individual autonomy of study participants. This
is evidenced, for example, through the process of informed and ongoing consent –
ongoing consent is informing individuals of the right to withdraw from a research
study at any time – and through recognising and respecting an individual’s right to
anonymity, confidentiality and privacy. In the sample ethics proposal in Example 13.2,
you can see that informed consent is emphasised and the researchers will usually
show how they obtain consent with a copy of the form that prospective participants
would need to see before they decided to take part.

In order to gain fully informed consent, you will need to look at how well your
prospective participants can understand the information about the study. You need
this information to be accessible to people who may not have English as a first lan-
guage and you may need to consider ensuring that the questionnaire items are
phrased in a simple and comprehensible way. In Example 13.2, you can see the re-
searchers considered the possibility of translating the questionnaires into a range
of languages. The researchers haven’t mentioned whether the information sheet
would be translated into some of the most commonly spoken languages as well, so
this might need to be made clearer before ethical approval can be given to this pro-
posed study.

Beneficence

This principle is based on the requirement to benefit the individual or patient. In the
context of a research study therefore there is a requirement to safeguard the welfare
of all study participants, for example clients, patients, colleagues and fellow re-
searchers. It is also considered unethical to undertake research that will be of no poten-
tial benefit to either participants or wider society. The ethics proposal in Example 13.2
makes a strong case for the Health Fax as having a variety of potential benefits, par-
ticularly in enabling the children concerned to be more aware of issues relating to
their health. The ethics proposal highlights the importance of having the Health Fax
as a vehicle for schoolchildren to discuss their health concerns with their school
nurse, although it would appear from the proposal that it is not clear what parts of
the process of using the Health Fax provide the most optimal benefits in promoting
schoolchildren’s health.

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Ethical considerations

Non-malfeasance

This consideration is also closely associated with beneficence and assumes that no
harm will come to the individual as a result of taking part in the research study. How-
ever, all research carries with it some risk of harm, however minimal. Depending on
the nature and scope of the study the potential harm may be physical, such as being
involved in a drug trial, or risks to emotional well-being (e.g. exploring a patient’s ex-
periences of a particular illness or care experience and the impact for the individual
in revisiting past experiences). It is therefore necessary to consider the possible
risks and to identify, minimise and address these when considering the scope of
your research study. In the example that we gave in Example 13.2, you can see that
many of the questions in the ethics form are concerned with looking at possible
risks to the well-being of the participants. The REC application form asks about
whether participants are likely to be at risk of physical and psychological harm, and
the researchers attempt to show how the schoolchildren will be protected when tak-
ing part. It is not likely that participants in a study involving questionnaire surveys
or interviews will be at risk of a great deal of psychological harm, but this all
depends on the questions being asked as some enquiries may be intrusive and up-
setting. As a result, it is usually common practice to have a copy of the survey or
interview schedule enclosed in the ethics application, so that the REC can gauge the
acceptability of the questions to be asked.

Justice

This principle is concerned with ‘fairness’ and translated within the context of re-
search will always require the needs of participants to come before the objectives of
the research, for example that participants are not coerced or feel obliged to take
part in a research study by virtue of the pre-existing relationship (e.g., a nurse–
patient relationship) and as such the relationship between the researcher and
the person being researched must always be considered. In the sample proposal in
Example 13.2, this is something worth considering as the application outlines the
school nurses as being the persons responsible for handing out the questionnaire to
the schoolchildren. This is potentially problematic as some of the children may feel
pressurised to take part due to their pre-existing relationship with the school nurse.
Some RECs may argue that it would be best to have an independent researcher who
would take responsibility for administering and organising the collection of the ques-
tionnaires so that the nurse–patient power dynamic does not lead to an unfair con-
text within which the research will take place.

Based on these principles, the rationale for seeking ethical approval stems from a
clear obligation to carry out research that recognises and protects the safety, well-
being and dignity of study participants while at the same time enabling high-quality
research to be undertaken. As such, obtaining ethical approval prior to undertaking
your research study is paramount to ensuring the efficacy of your study and an
ethics committee will closely review the research protocol, and other relevant project

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Chapter 13 Going forward: A step-by-step guide from research idea to ethics application

documentation to ensure that the dignity, rights, safety and well-being of research
participants will be protected throughout the research.

The nature and scope of your research will determine the procedures and level of ap-
proval that you will need to obtain prior to undertaking the research. The research and
development department in your NHS Trust or your local REC will be able to advise you
on procedures to be undertaken prior to starting your research study. The NRES (2007)
has published a leaflet, ‘Guidance for applicants to the National Research Ethics Ser-
vice’ and this takes you through some of the terminology commonly used in the ethical
review process, considerations to bear in mind before you apply for approval, and a de-
cision flow-chart on how and were to make your application. The NRES has identified
that RECs should usually aim to come to a decision on an ethics application within the
period of 60 calendar days, although this timeline of activities could be affected by the
REC needing to get clarification on the content of your application.

We would strongly advise you to ensure that you spend time to complete your
application as thoroughly as possible as an ethics committee will make their decision
regarding your application on the basis of the information that you have supplied.
Before submitting your application you may want to enlist the help of a critical friend
who may be able to identify potential ambiguities in your application. The NRES
(2007) also requests that it is a desirable thing for proposed studies to have confirma-
tion that any resources necessary to fund a project have already been agreed, and
that the proposed study will also have been subjected to peer review (i.e. critiqued by
others with sufficient expertise to comment on the scientific quality of the study).
Some studies might only pose a minimal risk to patients or involve examining routine
treatment; if this is the case, the researchers could apply to be exempt from requiring
site-specific assessors to inform the REC about the suitability of the research team
and the research environment. Most importantly, the research and development de-
partment will also need to have approved of the proposed study before it can begin.

As you can see, there are a number of requirements that need to be satisfied
before research can be carried out in the UK’s National Health Service (NHS). You will
need to bear in mind that the requirements, criteria and processes for approving
health care research might vary in other countries so you might need to familiarise
yourself with these systems before you carry out your research. Overall, although
these systems of ethical adherence might seem like a number of hurdles that need
to be jumped over before you can even speak to patients/service users about your re-
search, the welfare of these people should remain paramount in your mind before
taking those first steps.

Self-assessment exercise

Reviewing a research proposal

Have a look at the following brief research proposal. Imagine that you are part of a
panel making decisions on whether different health care studies can be funded.

350

Self-assessment exercise ▲

User and carer involvement in nurse education programmes:
developing a meaningful participant framework

Background
The involvement of users and carers in the planning, delivery and evaluation of health
service provision is increasingly being recognised as a central component in assuring the
maintenance of, and informing the ongoing improvement of, the overall quality of care
delivery (Brooker 1997). In a general sense user involvement is not a new concept, with
the World Health Organization (WHO) identifying the importance of patient’s involve-
ment in their own health care over two decades ago (Flanagan 1999). Recently a number
of national policy initiatives (DoH 1989, 1994) and other documentation (English Na-
tional Board 1996) have provided greater clarity regarding both the scope and direction
of user involvement within health care provision, with user participation in education
and training programmes for health care professionals being recognised as an essential
component within this process. However, although user and carer participation in the de-
velopment of education programmes and care delivery is now well established, there
have also been important questions raised regarding the extent to which user and carer
involvement has been translated into meaningful ‘active’ partnerships rather than ‘to-
kenistic consultation’ (Forrest et al. 2000). In addition, it has also been recognised that
the nature of the user–professional relationship, in terms of perceived balance of power,
raises issues regarding the necessity to provide clear reciprocal structures for successful
participation in the future (Forrest et al. 2000).

Aims of the project
The aims of the proposed project are:

• To provide an in-depth review of the salient literature in this area
• To explore the current situation regarding evaluation of user and carer participation

in nurse education
• To identify key areas where user and carer participation may be further developed
• To develop a clear supportive framework for active user and carer participation in

nurse education programmes in the future.

Methods

Phase 1
Phase 1 of the project will involve an in-depth review of the literature surrounding user
and carer involvement in the development of care delivery in general and more particu-
larly, in the continuing development of educational programmes for nurses (with an onus
towards pre-registration education programmes). In addition, there will an evaluation of
Student Evaluation of Module (SEM), with regard to user and carer involvement and
other relevant school documentation. Phase 1 of the project will provide an evaluation of
the present situation and will serve as a foundation for Phase 2 of the overall project.

Phase 2
Using Phase 1 of the project as a foundation, Phase 2 of the study will involve the collec-
tion of empirical data through focus groups with nursing students and lecturers from
within the School of Nursing. In addition, focus groups will also be undertaken with a
number of users and carers. It is envisaged that analysis of focus group data will inform
the development of a clear supportive framework for active user and carer participation
in nurse education programmes in the future.

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Chapter 13 Going forward: A step-by-step guide from research idea to ethics application

References
Brooker D.J. (1997) Issues in user feedback on health services for elderly people. British

Journal of Nursing, 6, 159–162.
Department of Health (1989) Working for Patients: Department of Health: Official Publica-

tions. London: HMSO.
Department of Health (1994) Nurse, Midwife and Health Visitor Education: A Statement of

Strategic Intent. London: Department of Health.
English National Board (1996) Learning from Each Other. London: English National Board.
Flanagan J. (1999) Public participation in the design of educational programmes for can-

cer nurses: a case report. European Journal of Cancer Care, 8, 107–112.
Forrest S. Masters H. and Brown N. (2000) Mental health service user involvement in nurse

education: exploring the issues. Journal of Psychiatric and Mental Health Nursing, 7,
51–57.

Questions
● What do you think are the main strengths of the proposal?
● How could the proposal be strengthened or which areas need further clarification?

Summary

Overall, this chapter has taken you through many of the initial stages that need to
be satisfied before you carry out your nursing research. We have aimed to equip
you with the skills to develop practice-informed research questions and to then ask
searching questions of the literature. You should be able to identify people who are
possible stakeholders in your research and potential collaborators. From there on
in this chapter, you will have been given some tools for developing a research pro-
posal and you are encouraged to invite colleagues to critique your proposals once
you’ve drafted them. Finally, we have enabled you to be more aware of the nuances
of assessing whether a proposed study is ethical by using four key principles of
autonomy, beneficence, non-malfeasance and justice. You have been shown the
system that currently exists in the NHS for centrally regulating processes of eth-
ical adherence in England, Wales, Scotland and Northern Ireland.

352

Final comments: taking those first
steps to becoming an independent
nurse researcher

Before you start on your research project we would like to remind you of some of the
fundamental questions to address when you’re deciding whether to embark on a re-
search project. These questions are related to many of the issues that we’ve raised
throughout this chapter and we would urge you to revisit them as often as possible at
different stages of the research process. This approach should enable you to be a
more reflective and effective nurse researcher in the future.

The key questions to consider are:
● Is it an important and relevant area to be researched?
● Can the research have an impact on clinical care, specifically the well-being of pa-

tients and the well-being of those who provide care to them?
● Is the research area amenable to measurement? How would you analyse the data

collected and how would you interpret the findings?
● Can the research be done in an ethical way?
● Can the research be supported with sufficient human and financial resources?
● How might you put some of the implications from your study findings into changes

to practice? What if the study uncovers the need for spending more resources to
improve clinical care? Can the health care organisation that you work in help to fi-
nance these potential improvements?
We trust this book will have given you all of the essentials that you need to be an
effective, ethical and efficient nurse researcher and wish you well in your research
endeavours!

353

Answers to self-assessment exercises

Chapter 1

Extract 1: Difficulties in administering medication to older mental health inpatients
(Dickens et al., 2007)
Answer: analysis/presentation, research and quantitative.

Extract 2: NICE guidance on antenatal and postnatal mental health (Hairon, 2007)
Answer: literature, research and quantitative.

Extract 3: A study on effects of working unsocial hours. (Crew, 2006)
Answer: analysis, research and qualitative.

Extract 4: Procedural restraint in children’s nursing: using clinical benchmarks (Bland et al.,
2002)
Answer: literature, theory.

Chapter 2

Study 1
Answer: cohort study. It is a cohort study because it is measuring people over time (longi-
tudinal design) and looking forwards in the measurements (i.e. having a prospective
focus).

Study 2
Answer: RCT. This is because there was random assignment of participants to treatments.
Patients were measured before and after treatment was received.

Study 3
Answer: Cross-sectional survey. This is because surveys were done on groups of children
in a specific age group but the same children were not studied over different years. Over
two years of the study period, the researchers took ‘snapshots’ of net ownership and the
presence of parasites in the blood of children aged under the age of 2.

Study 4
Answer: Cross-sectional survey. This is because participants were only measured at one
time point. The researchers are only looking at the relationship between the number of
cups of green tea consumed and measurements of health through taking blood samples
from participants.

Study 5:
Answer: Case-control study. This is because people with lung cancer (i.e. the ‘cases’) were
selected and compared with a control group who did not have lung cancer (i.e. the ‘controls’).
The measurements were retrospective (i.e. looking backwards) by examining the medical his-
tory of the cases and the controls.

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Answers to self-assessment exercises

Chapter 7

The main issues that we could find from the dialogue included:

● Involvement of all stakeholders
● Confidentiality of data collection
● Communicating findings to stakeholders
● Arranging sufficient time to execute the project properly
● Getting organisational support to do the project
● How people’s bad experiences of the recommendations of action research may deter

people from taking part in future studies (i.e. the problems in working with the
pharmacists)
● Importance of agreeing roles and responsibilities: making it clear how the project is
being led and how participants are facilitated to take part without fear of recrimination
● Making it clear as to what can or can’t be changed organisationally as a result of the ac-
tion research
● Being committed to the agenda as it evolves throughout the duration of the action
research
● Being open to the idea that cultural change, as a result of action research recommen-
dations, may need to occur at all levels in an organisation and not just among one
group of staff.

Act II. Issues to consider when involving patients
and relatives/carers in action research

Question: Having read through this scenario, what are the main issues concerned with in-
volving patients and carers in action research?

Suggested answers:

● Think about the power dynamics involved and the inequalities between nurses and
their patients. There might be difficulties in getting patients to be open in their views
when talking to a researcher if they think that what they say could get back to the
health care team and adversely affect the quality of care that they receive. Often pa-
tients are resistant to changes to their health care, particularly if they are already sat-
isfied with what they’re receiving. As a result, some patients could be defensive in their
responses in order to maintain the status quo with their care.

● Consider the importance of the context of action research and how it’s presented to
the patients. Do the patients think that all comments they make will be incorporated
and acted upon? Do the patients have a clear idea as to what you want to study and
how does this overlap with what they want you to research?

● Relative/carer participation. To what extent could you, or should you, involve relatives/
carers in setting the agenda of the action research, in collecting data from them and in
getting them to comment on the findings for the study? In which circumstances might
relative/carer participation be especially important?

● Think about the ways of collecting data from patients and the things you’re asking
from them. Some topics might be highly sensitive (such as the one touched upon in this
scenario) and very problematic to discuss in a group. Is a one-to-one interview or a

356

Answers to self-assessment exercises

questionnaire more appropriate? Might you want to offer a variety of ways in which
participants can voice their opinions and perceptions?

● What sorts of questions are you aiming to ask? Questions on their experiences and
how they feel? Or questions on their views concerning service improvement and are
you then wanting to look at whether the improvements should be systemic or related to
the behaviour of staff?

● Think about fatigue that patients might feel if involved in too many studies all at once.

● Look to addressing misperceptions of what can realistically be achieved and what
are realistic expectations of a health service. Is it realistic to expect nurses to escort
all older patients to the bathroom? Is it feasible to presume that older patients will have
no risk of falling when in hospital?

● Think about what needs to be done if a patient/carer/relative reports unsafe/
unethical/criminal practice. What is your role as a researcher and how might this
conflict with your role as a registered nurse?

● Consider the viability of future possible actions arising from data collected from
patients/relatives/carers. Is cultural change needed? Do staff need additional training
or do new administrative and monitoring systems require setting up to make bad prac-
tices more noticeable? Being able to monitor bad practices may be particularly difficult
outside of the hospital setting so do watch out for the problems involved with this.

Act III. Issues to consider when involving staff in action research

Question: Having read through this scenario, what are the main issues concerned with in-
volving staff in action research?

Suggested answers:

● Setting the agenda as to what to study and how to study it. How do the staff members
view the action research agenda? Do they perceive that they can have some input into
it? Do they see the action research agenda as being mutually beneficial to both pa-
tients and themselves? Consider the ultimate purpose of the study – do you want staff
to be made more aware of the issues around a certain problem in clinical practice? If so,
is action research the most appropriate method to do this or are there alternative ways
of getting staff to discuss and explore these issues?

● Collecting information from staff:

– Think about the extent to which you wish to get staff taking part in the action
research and the amount of time that they would have available to commit to partic-
ipation. Is it too much to ask to get staff to take part in focus group or one-to-one
interviews that may take several hours? Are there other means of obtaining their
views in a rigorous and non-intrusive way?

– Also, consider issues relating to confidentiality and anonymity, particularly if you are
asking staff to report instances of poor practice. Would some staff members be more
comfortable talking in a more general way? If so, how useful could this still be for
your research?

● Implementing actions after feedback has been received. Consider the ways in
which some staff may prefer to be informed about the action research’s findings and
recommendations. Would you want to communicate this through a newsletter or
through posters or guidance leaflets? Would you want to stage regular sessions with

357

Answers to self-assessment exercises

staff or with people who can filter the information to all levels within the health care
team? Could you use a train-the-trainer type of approach by getting influential mem-
bers to help change attitudes or practices within the team?

Chapter 10

Suggested answers:

[CA1]: Issue 2 – Aims: The aims seem relatively clear. It is not clear whether the authors
will be able to deliver on all of these aims so we’ll need to look at how they do in the find-
ings and discussion sections.

[CA2]: Issue 4 – Design: The use of qualitative research methods looks appropriate, given
the exploratory nature of the study and the lack of knowledge into the ways in which first-
time fathers perceive their experiences of being depressed after the birth of their children.

[CA3]: Issue 6 – Sample and sampling: How else could the researchers have accessed the
potential participants? It may be that the authors could have contacted local antenatal
groups, although some fathers may not go to these groups. Also, the fathers who may be
depressed before the birth may not be the same ones who are depressed after the birth.

[CA4]: Issue 6 – Sample and sampling: Inclusion and exclusion criteria seem clear.

[CA5]: Issue 5 – Ethics: It looks like the authors have taken great care to address the gen-
eral ethical issues of getting ethics committee approval and to focus on the specific needs
of the participants in terms of protecting their well-being. What are the other ethical
issues associated with this topic area? Could stigma surrounding mental health and the
cultural aspects associated with men’s health make it difficult for the participants to speak
out about this?

[CA6]: Issue 7 – Data collection and analysis: What other methods might be used before
carrying out the full study? For example, a pilot study could be conducted to test out the
acceptability of some of the questions posed and could aid in the development of the
semi-structured questionnaire used in the actual study.

[CA7]: Issue 7 – Data collection and analysis: The interviews seem quite brief. Although it
is transparently clear about the process of collecting the data, it is not likely that the inter-
views have been long enough to provide in-depth, ‘rich’ data.

[CA8]: Issue 7 – Data collection and analysis: It isn’t clear whether grounded theory is an
appropriate approach to take with the data. From later on, it appears as if the three so-
called ‘themes’ of cognitive, affective and behavioural symptoms of postnatal depression
among fathers are purely a function of the questions being asked rather than of what the
participants are saying.

[CA9]: Issue 7 – Data collection and analysis: The cognitive, affective and behavioural
‘themes’ don’t appear to be themes at all because these were the sorts of issues that were
already put down in the interview schedule for discussion. There needed to be more of a
focus on the actual content of what the participants have said and a drawing out of
themes from this content. For instance, in the so-called theme of ‘cognitive symptoms’,
there are a couple of quotes on the ways in which the participants see their role and how
their world-view has been altered after becoming fathers; these sorts of insights seem to
suggest that there is a possible theme regarding the role of the father and the place of
this role within society and the family unit.

358

Glossary

Action research A part of qualitative research which involves a reflective process of prob-
lem solving led by individuals working in teams to improve the way they address issues
and solve problems.

Alternative hypothesis A hypothesis that refers to a statement that the results found in
a study are expected to show a statistically significant relationship.

Bar chart A bar chart is a graphical display of frequencies of scores used commonly with
categorical-type data.

Case–control designs Research designs that researchers use to identify or study the pos-
sible variables that may contribute to various health factors.

Categorical data Data comprises categories that have no numerical value or order.

Categorical-type data A term used specifically for this book that describes data that has
been put in categories and does not have any numerical properties.

Chi-square The chi-square test of association allows the comparison of two categorical-
type data to determine if there is any relationship between them.

Clinical trial A study that is conducted to allow safety and efficacy data to be collected for
new drugs or treatments.

Cohort study design A study that examines a common characteristic among a sample of
individuals.

Cohort Group of people.

Confounding variable An unforeseen, or unaccounted-for, variable that jeopardises the
validity of an experiment’s outcome.

Construct validity This is a kind of validity that refers to the underlying concepts (or ‘con-
structs’) that are being measured. For example, if a researcher studying the mental health
of service users with depression has a theory that depression has two main components
(or ‘constructs’), then this researcher will want to see if these two components surface in
how the service users think, feel and act.

Constructivism The principle that knowledge is developed (or ‘constructed’) according to
frameworks and ways of seeing the world. This knowledge is continually shaped and re-
shaped, depending on any new information and new situations that are encountered.

Continuous data A set of data is said to be continuous if the values/observations belong-
ing to it may take on any value. Continuous data, unlike discrete data, can have decimal
points.

Continuous-type data A term used specifically for this book that describes data that has
been ordered numerically or given numerical properties in some way.

359

Glossary

Control group The standard by which experimental observations are evaluated by using
a set of participants in which they either receive no treatment/intervention or a placebo.

Criterion validity This is a kind of validity that refers to the measuring of a new assess-
ment tool in relation to a benchmark or gold standard. For instance, if a researcher is de-
veloping a new tool to measure preoperative anxiety in patients, the researcher will
examine how strongly a patient’s score on this tool corresponds with another measure-
ment, like the Anxiety subscale of the Hospital Anxiety and Depression (HAD) scale.

Cross-sectional survey A research design that provides the researcher with a picture of
what might be occurring in a sample or population of people at a particular time.

Descriptive statistics Statistics that are techniques used to summarise/describe data.

Diagnostic trials A type of clinical trial where research methods are designed for devel-
oping tools that can be used for recognising or detecting a particular disease.

Discrete data Continuous-type data. A set of data is said to be discrete if the values are
distinct and separate and represent whole numbers. Discrete data, unlike continuous data,
cannot have decimal points.

Double-blind A clinical trial or study design in which neither the participating individuals
nor the study staff knows which participants are receiving the experimental drug and
which are receiving a placebo (or another therapy).

Ecological validity A form of validity. The extent to which the findings can be generalised
beyond the current situation.

Effect size The term given to a group of indices that measure the magnitude of a statisti-
cal finding.

Empirical Data based on research, not on a theory.

Ethnography A type of qualitative research which treats a group of people as an anthro-
pologist would an unknown tribe, with detailed descriptions of how they live.

Ethnomethodology This relates to the general philosophy of seeing the world and doing
research, which involves looking for the formal and informal rules and practices that oper-
ate among a group of people.

Evidence-based practice An approach where the best, most appropriate, most suitable
methods are used based on theoretical and empirical evidence.

Expected frequencies In a contingency table, Crosstabs in SPSS, the expected frequen-
cies are the frequencies that would be expected to be obtained in each cell of the table
from the sample if everything was random. Expected frequencies are spread evenly across
the cells. Most commonly used with a chi-square test.

External validity If a study has external validity, its results will generalise to the larger
population.

Face validity This is one of the weakest forms of validity and is sometimes called ‘accept-
ability’. Face validity refers to whether a measurement appears to be assessing the
concept in question. For example, using a thermometer to establish a person’s depression
levels might be seen as having relatively low face validity as, on the face of it, the ther-
mometer doesn’t seem to be tapping into a person’s mental well-being.

360

Glossary

Focus group A group discussion, in which a moderator encourages a small group of peo-
ple to focus on and discuss a topic.

Frequency table A frequency table is a way of summarising data by assigning a number
of occurrences to each level of variable.

Genetic tests A type of screening test that looks for inherited genetic markers.

Grounded theory Practice of developing other theories that emerge from observing a
group and their observable experiences. Researchers then add their own insight into the
existence of those experiences.

Histogram A histogram is a graphical display of frequencies of scores used commonly
with continuous-type data.

Hypothesis/hypotheses Suggested explanation or statements of the possible relation-
ship between variables.

Imaging tests A type of screening test that uses X-rays, radioactive particles, sound
waves or magnetic fields whose information can be analysed after passing through tissues
of the body and that produce pictures of areas inside the body.

Independent samples Independent samples are those selected from the same population
or different populations but which are considered independent of each other (for example,
men and women).

Inferential statistics Comprises the use of statistical tests to make inferences concerning
the nature of the relationship between variables.

Interpretative phenomenological analysis (IPA) An approach in qualitative research
which is designed to offer insights into how a person, in a particular context, makes sense
of a phenomenon.

Interval data/variables Have levels that are ordered and numerical. Interval data is dis-
tinctive from ratio data as interval data have no absolute zero (i.e. absence of what is
being measured).

Intervention study A study where the researcher assesses or measures the effects of an
intervention.

Longitudinal survey A research design in which the same surveys are observed repeat-
edly over a period of time.

Mann-Whitney U statistical test A non-parametric statistical test for comparing scores of
two groups on a continuous-type variable.

Mean An average statistic worked out by adding all the values together, and then divid-
ing this total by the number of values (e.g. the mean of 6 and 4, would be 10 divided by 2,
which is 5).

Median The median is the value that appears halfway in a set of data when that data has
been ordered by value (e.g. in the set of values 1, 2, 3, 4, 5 – 3 is the median).

Mode The mode is the most frequently occurring value in data (e.g. in the set of values 1,
2, 2, 2, 5 – 2 is the mode).

361

Glossary

Negatively skewed distribution A distribution of scores in which the majority of scores
fall to the right of the distribution.

Non-parametric statistical tests Non-parametric tests are often used instead of para-
metric counterparts when certain assumptions about the underlying population are ques-
tionable, for example when continuous-type data is not normally distributed.

Normal distribution A distribution of scores shaped like a bell curve in which the same
number/percentage of scores fall on either side of the centre of the distribution.

Null hypothesis A hypothesis that refers to a statement that the results found in a study
are no different from what might have occurred as a result of chance.

Observational study A study where the researcher observes the effects of a phenomenon.

Observed frequencies In a contingency table, Crosstabs in SPSS, the observed frequen-
cies are the frequencies actually obtained in each cell of the table, from the sample. Most
commonly used with a chi-square test.

Ordinal data Data with values/observations belonging to it can be ranked (put in order) or
have a rating scale attached.

Paired-samples t-test (also known as dependent-groups t-test) A paired-samples t-test
is used to determine whether there is a significant difference between the average values
of the same variable made under two different conditions among the same sample.

Pearson correlation coefficient A correlation coefficient (r) is a number between Ϫ1 and
1 which indicates the degree to which two variables are statistically significantly related.

Percentile Percentiles are values that divide a sample of data into one hundred groups
(i.e. 100 per cent), each representing 1 per cent.

Phase I trials A phase in a set of clinical trials that comprises initial studies to gain early
evidence of the effectiveness of drugs and their side effects.

Phase II trials A phase in a set of clinical trials that comprises controlled clinical studies
conducted to evaluate the effectiveness of the drug and to determine the common short-
term side effects and risks.

Phase III trials A phase in a set of clinical trials that comprises controlled and uncon-
trolled trials after preliminary evidence suggesting effectiveness of the drug has been
obtained.

Phase IV trials A phase in a set of clinical trials that comprises post-marketing studies to
gain additional information including the drug’s risks, benefits, and optimal use.

Phenomenology A qualitative research approach concerned with understanding a popu-
lation’s behaviours from that population’s point of view.

Pie chart A pie chart is a pictorial way of summarising a set of categorical-type data.

Placebo A placebo is an inactive pill, liquid or powder that has no treatment value.

Population A population is any entire collection of people.

Positively skewed distribution A distribution of scores in which the majority of scores fall
to the left of the distribution.

362

Glossary

Prevention trials A type of clinical trial where research methods are designed to look for
better techniques to prevent disease.

Probability value (p-value) The probability value (p-value) in a statistical hypothesis test
is the probability of getting a value of the test statistic higher than that observed by
chance alone.

Protocol A study plan on which all clinical trials are based.

Qualitative Aspect of the research process that may be estimated by meaning or lan-
guage. Results are expressed in non-numerical terms.

Quality of life trials A type of clinical trial where research methods are designed to ex-
plore ways to improve the quality of life for individuals with an illness.

Quantitative Aspect of the research process that may be estimated by quantity or numbers.

Quartile. Quartiles are values that divide a sample of data into four groups containing
equal numbers of observations.

Quasi-experiment Similar to randomised experiments but uses nonrandomized groups.

Random sample Data that have been drawn from a population in such a way that each
piece of data that was selected was done so that each piece of data had an equal opportu-
nity to appear in the sample.

Randomisation A method based on chance by which study participants are assigned to a
treatment group.

Randomised controlled trial A study in which participants are randomly assigned to one
of two or more treatment conditions of a study/clinical trial.

Ratio data/variables Have levels that are ordered and numerical. Ratio data is numerical,
but is distinctive from interval data because ratio data can have an absolute zero (i.e. ab-
sence of what is being measured).

Sample A sample is a group of units/cases (e.g. people, test results) selected from a larger
group (the population) of units/cases. Researchers study samples in the hope of drawing
conclusions about the larger group.

Screening trials A type of clinical trial where research methods are designed to develop
and assess screening tools to detect certain diseases.

Semi-inter quartile range (SIQR) The semi-inter quartile range is a measure of the ranges
of scores between the upper and the lower quartiles divided by two. Also a measure of the
extent to which a set of scores vary. Often accompanies the reporting of the median.

Single-blind A study in which one party, either the investigator or participant, is unaware
of what drug/treatment the participant is taking.

Spearman correlation coefficient A statistical test that produces a correlation coeffi-
cient (rho) used with non-parametric data that produces a number between Ϫ1 and 1,
which indicates the degree to which two variables are related.

Standard deviation A measure of the extent to which a set of scores vary. Often accom-
panies the reporting of the mean.

363

Glossary

Statistical inference. Statistical inference makes use of information from a sample to
draw conclusions (inferences) about the population from which the sample was taken.
Statistical significance A result is statistically significant if it is probable not to have
occurred by chance.
Stratified sampling A method of sampling from a population based on the characteristics
of the population on which the selection is based.
Symbolic interactionism Researchers use this approach to examine how people interpret
and react to a variety of labels and symbols that exist within a social world.
Survey A research tool that includes questions (either open-ended or forced choice) and
employs an oral or written method for asking and answering the questions.
Treatment trials A type of clinical trial where research methods are designed to test new
drugs or new combinations of drugs, new treatments, or new types of surgery.
Type I error When the use of a statistical test incorrectly reports that it has found a sta-
tistically significant result where none really exists.
Variable Phenomena that vary.
Wilcoxon sign-ranks statistical test A non-parametric statistical test for comparing scores
on the same continuous-type variable on two occasions (or for comparing matched groups).

364

References

Abdulla, S., Schellenberg, J.A., Mukasa, O., Marchant , T., Smith, T., Tanner, M. and Lengeler,
C. (2001) Impact on malaria morbidity of a programme supplying insecticide-treated nets
in children aged under 2 years in Tanzania: community cross-sectional study. British Med-
ical Journal, 322, 270–273.

Ahmed, Q.A., Memish, Z.A., Allegranzi, B. and Pittet, D. (2006) Muslim health-care workers
and alcohol-based handrubs. The Lancet, 367 (9515), 1025–1027.

Alspach, G. (2006) Editorial. Nurses’ use and understanding of evidence-based practice –
some preliminary evidence. Critical Care Nursing, 26 (6), 11–12.

Arai, L. (2003) Low expectations, sexual attitudes and knowledge: explaining teenage
pregnancy and fertility in English communities. Insights from qualitative research. The
Sociological Review, 51 (2), 199–217.

Barr, W. (2000) Characteristics of severely mentally ill patients in and out of contact with
community mental health services. Journal of Advanced Nursing, 31(5), 1189–1198.

BBC News (2005a) Epidurals increase birth aid need. Available at http://news.bbc.co.uk/1/
hi/health/4371552.stm, accessed 31 July 2009.

BBC News (2005b) Fresh drive to wipe out superbug. Available at http://news.bbc.co.uk/1/
hi/scotland/4370730.stm, accessed 31 July 2009.

Beauchamp, T. and Childress, J. (2001) Principles of Biomedical Ethics, 5th edn. New York:
Oxford University Press.

Beck, A.T., Steer, R.A. and Brown, G.K. (1996) Beck Depression Inventory ® II. San Antonio,
TX: Pearson.

Becker, H. (1993) How I learned what a crock was. Journal of Contemporary Ethnography,
22, 28–35.

Beech, M. (2002) The way forward? Journal of Community Nursing, 16 (3), online edition.
Available at http://www.jcn.co.uk/journal.asp?Year=2002&Month=03&ArticleID=441,
accessed 4 August 2009. NB Registration is mandatory before you can access this article
via www.jcn.co.uk.

Bennett, J., Done, J., Harrison-Read, P. and Hunt B. (1995) A side effect scale/checklist to
assess the side effects of anti psychotics by community psychiatric nurses. In E. White and
C. Brooker (eds) Community Psychiatric Nursing. A Research Perspective. London: Chapman
and Hall, pp. 1–19.

Bennis, W. and Nanus, B. (1985) Leaders: The Strategies for Taking Charge. New York:
Harper and Row.

Bland, M., Bridge, C., Cooper, M., Dixon, D., Hay, L. and Zerberto, A. (2002) Professional
nursing. Procedural restraint in children’s nursing: using clinical benchmarks. Professional
Nurse, 17, 712–715.

365

References

Blumer, H. (1969) Symbolic Interactionism: Perspective and Method. Berkeley, CA: University
of California Press.

Brent Teaching Primary Care Trust (2004) District Nursing Service Guidelines. Available at
http://www.brenttpct.org/doxpixandgragix/DNGUIDELINES.pdf, accessed 4 August 2009.

British Heart Foundation (2004) Coronary Heart Disease Statistics. London: The British
Heart Foundation. Available at http://www.heartstats.org/.

Brown, J.B. and Addington-Hall, J. (2008) How people with motor neurone disease talk
about living with their illness: a narrative study. Journal of Advanced Nursing, 62, 200–208.

Brown, S.A., Harrist, R.B., Villagomez, E.T., Segura, M., Barton, S.A. and Hanis, C. L. (2000).
Gender and treatment differences in knowledge, health beliefs, and metabolic control in
Mexican Americans with type 2 diabetes. Diabetes Education, 26 (3), 425–438.

Bryman, A. and Cramer, D. (1997) Quantitative Data Analysis with SPSS for Windows. A
Guide for Social Scientists. London: Routledge.

Bysouth, D. (2007) “Jolly good nutter”: a discursive psychological examination of bipolar
disorder in psychotherapeutic interactions. PhD thesis, Murdoch University, Australia. Avail-
able at http://wwwlib.murdoch.edu.au/adt/pubfiles/adt-MU20071217.34447/02Whole.pdf,
accessed 15 August 2009.

Carney, T.F. (1990) Collaborative Inquiry Methodology. Windsor, Ontario, Canada: University
of Windsor, Division for Instructional Development.

Carr, W. and Kemmis, S. (1986) Becoming Critical. Lewes: Falmer Press.

Castonguay, G. (2008) Short–stretch or four-layer compression bandages: an overview of
the literature. Ostomy/Wound Management, 54 (3), 50–55.

Clabo, L.M.L. (2008) An ethnography of pain assessment and the role of social context on
two postoperative units. Journal of Advanced Nursing, 61, 531–539.

Clegg, F. (1982) Simple Statistics: A Course Book for the Social Sciences. Cambridge:
Cambridge University Press.

Cohen, J. (1988) Statistical Power Analysis for the Behavioral Sciences. New York: Academic
Press.

Coubrough, A. (2008) Minister calls for London’s views on care for older people.
Nursing Times, 24 July. Available at http://www.nursingtimes.net/whats-new-in-
nursing/minister-calls-for-londons-views-on-care-for-older-people/1744134.article, accessed
15 August 2009.

Cowan, J. (1998) On Becoming an Innovative University Teacher. Buckingham: SRHE and
Open University Press.

Cox, J.L., Holden, J.M. and Sagovsky, R. (1987) Detection of postnatal depression: develop-
ment of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry,
150, 782–786.

Crew, S. (2006) A qualitative study on effects of working unsocial hours. Nursing Times,
102 (23), 30–33. Available at http://www.nursingtimes.net/ntclinical/a_qualitative_study_
on_effects_of_working_unsocial_hours.html, accessed 15 August 2009.

366

References

Dartford and Gravesham NHS Trust (undated) Bridging team. Available at http://
www.dvh.nhs.uk/page.asp?node=394&sec=Bridging_Team, accessed 4 August 2009.

Davies, C. (2003) Establishing referral criteria. Journal of Community Nursing, 17 (7).
Online edition available at http://www.jcn.co.uk/journal.asp?Year=2003&Month=07&
ArticleID=597, accessed 4 August 2009. NB Registration is mandatory before you can
access this article via www.jcn.co.uk.

Davies, C.A. (1999) Reflexive Ethnography: A Guide to Researching Selves and Others.
Abingdon: Routledge.

Denzin, N. (1978) Sociological Methods: A Sourcebook, 2nd edn. New York: McGraw Hill.

Department of Health (2001) The National Service Framework for Older People. London: HMSO.

Dheensa, S. and Williams, G. (2008) The Psycho-Social Effects of Living with Neurofibro-
matosis Type 1: An Interpretative Phenomenological Analysis. Poster presented at Health
Psychology Annual Conference, organised by Division of Health Psychology of The British
Psychological Society and the European Health Psychology Society, Bath, 9–12 September,
2008.

Dheensa, S. and Williams, G. (2009) ‘I have NF. NF does not have me’: an interpretative
phenomenological analysis of coping with Neurofibromatosis Type 1. Health Psychology
Update, 18 (1), 3–8.

Dickens, G., Stubbs, J. and Haw, C. (2007) Difficulties in administering medication to older
mental health inpatients. Nursing Times, 103 (15), 30–31.

Doll, R. and Hill, A.B. (1950) Smoking and carcinoma of the lung: preliminary report. British
Medical Journal, 2, 739–748.

Donne, J. (undated) Devotions Upon Emergent Occasions, Meditation XVII. See the follow-
ing for the full quotation: http://isu.indstate.edu/ilnprof/ENG451/ISLAND/index.html,
accessed 4 August 2009.

Eller, L.S., Kleber, E. and Wang, S.L. (2003) Self-reported research knowledge, attitudes
and practices of health professionals. Nursing Outlook, 51, 165–170.

Folkman, S. and Lazarus, R.S. (1978) If it changes, it must be a process: study of emotion
and coping during three stages of a college examination. Journal of Personality and Social
Psychology, 48, 150–170.

Foucault, M. (2003) The Birth of the Clinic. London: Routledge.

Gabrel, C. and Jones, A. (2000) The National Nursing Home Survey: 1995 summary. Vital
and Health Statistics, 146, 1–83.

Gibbs, G. (1988) Learning by Doing: A Guide to Teaching and Learning Methods. London:
Further Education Unit.

Glaser, B. (1978) Theoretical Sensitivity: Advances in the Methodology of Grounded Theory.
Mill Valley, CA: Sociology Press.

Greenhalgh, T. (2001) How to Read a Paper, 2nd edn. London: BMJ Books.

Guba, I. and Lincoln, Y. (2001) Guidelines and checklist for constructivist (aka Fourth Genera-
tion) evaluation. Available at http://www.wmich.edu/evalctr/checklists/constructivisteval.pdf,
accessed 22 September 2009.

367

References

Gustavsen, B. (2001) Theory and practice: the mediating discourse. In P. Reason and
H. Bradbury (eds) Handbook of Action Research. London: Sage, pp. 17–26.

Hairon, N. (2007) NICE guidance on antenatal and postnatal mental health. Nursing Times,
103 (13), 25–26. Available at http://www.nursingtimes.net/ntclinical/nice_guidance_on_
antenatal_and_postnatal_mental_health.html, accessed 15 August 2009.

Hammersley, M. and Atkinson, P. (1995) Ethnography: Principles in Practice, 2nd edn.
London: Tavistock.

Harper, N. (2006) Investigating the techniques adopted to socially readjust after the onset
of epilepsy in adulthood. Unpublished B.Sc. (Hons) Psychology with Social Science disser-
tation, Nottingham Trent University, Nottingham.

Harrington, A. (ed.) (1997) The Placebo Effect. An Interdisciplinary Exploration. Cambridge,
MA: Harvard University Press.

Hobgood, C., Villani, J. and Quattlebaum, R. (2005) Impact of emergency department vol-
ume on registered nurse time at the bedside. Annals of Emergency Medicine, 46, 481–489.

Hodgkins, C., Rose, D. and Rose, J. (2005) A collaborative approach to reducing stress
among staff. Nursing Times, 101 (28), 35–37.

Hrobjartsson A. and Gotzsche, P. C. (2001) Is the placebo powerless? An analysis of clini-
cal trials comparing placebo with no treatment. New England Journal of Medicine, 344,
1595–1602.

Imai, K. and Nakachi, K. (1995) Cross-sectional study of effects of drinking green tea on
cardiovascular and liver diseases. British Medical Journal, 310, 693–696.

Jacobson, B.F., Munster, M., Smith, A. et al. (2008) The BEST study – a prospective study to
compare business class versus economy class air travel as a cause of thrombosis. South
African Medical Journal, 93, 522–528.

Janis, I. (1972). Victims of Groupthink. Boston, MA: Houghton Mifflin.

Johns Hopkins Medicine (undated) Hospital at Home. Available at http:// www.hospitalat-
home.org/DGM/, accessed 4 August 2009.

Jones, A. (2002) The National Nursing Home Survey: 1999 summary. Vital and Health
Statistics, 152, 1–116.

Kanter, R.M. (1983) The Change Masters: Innovation for Productivity in the American
Corporation. New York: Simon and Schuster.

Kipling, R. (2001) Just So Stories. Mineola, NY: Dover Publications.

Kolb, D.A. (1984) Experiential Learning: Experience as the Source of Learning and Develop-
ment. Englewood Cliffs, NJ: Prentice-Hall.

Larkin, M., Watts, S. and Clifton, E. (2006) Giving voice and making sense in interpretative
phenomenological analysis. Qualitative Research in Psychology, 3, 102–120.

Laungani, P. and Williams, G. A. (1997) Patient-focused care: effects of organisational
change on the stress of community health professionals. International Journal of the Insti-
tute of Health Education, 35 (4), 108–114.

Lazarus, R.S. and Folkman, S. (1984) Stress, Appraisal and Coping. New York: Springer.

368

References

Lewin, K. (1951) Field Research in Social Sciences. New York: Harper and Row.

Limb, M. (2004) An evaluation survey of self-concept issues in adult clients undergoing
limb reconstruction procedures. Journal of Orthopaedic Nursing, 8, 34–40.

Luck, L., Jackson, D. and Usher, K. (2008) STAMP: components of observable behaviour
that indicate potential for patient violence in emergency departments. Journal of Ad-
vanced Nursing, 59 (1), 11–19.

Maltby, J., Day, L. and Macaskill, A. (2010) Personality, Individual Differences and Intelli-
gence. Harlow: Pearson Education.

Maltby, J., Day, L. and Williams, G. (2007) Introduction to Statistics for Nurses. Harlow:
Pearson Education.

Maslach, C. and Jackson, S.E. (1986) Maslach Burnout Inventory, 2nd edn. Palo Alto, CA:
Consulting Psychologists Press.

Mays, N. and Pope, C. (1996) Qualitative Research in Health Care. London: BMJ Publishing.

McGarry J. (2003) The essence of ‘community’ in community nursing: a district nursing
perspective. Health and Social Care in the Community, 11 (5), 423–430.

McGarry, J. (2007a) Defining Roles, Relationships, Boundaries and Participation between
Older People and Nurses within the Home Setting: An Ethnographic Study. Doctor of
Health Science thesis, University of Nottingham.

McGarry J. (2007b) Nursing relationships in ethnographic research: what of rapport?
Nurse Researcher, 14 (3), 7–14.

McGarry, J. (2009) Defining roles, relationships, boundaries and participation between
older people and nurses within the home: an ethnographic study. Health and Social Care in
the Community, 17 (1), 83–91.

McGarry J. and Arthur, A. (2001) Informal caring in late life: a qualitative study of the ex-
periences of older carers. Journal of Advanced Nursing, 33, 180–187.

McGarry, J. and Thom, N. (2004) User and carer involvement in nurse education pro-
grammes: towards the development of a supportive and meaningful participant frame-
work. Nursing Times, 100 (18), 36–39.

McKnight, M. (2006) The information seeking of on-duty critical care nurses: evidence
from participant observation and in-context interviews. Journal of the Medical Library
Association, 94, 145–151.

Mead, M. (1928) Coming of Age in Samoa. New York: William Morrow.

Mead, M. (1930) Growing up in New Guinea. New York: William Morrow.

Mead, M. (1935) Sex and Temperament in Three Primitive Societies. New York: William
Morrow.

Miles, M. and Huberman, A. (1994) Qualitative Data Analysis: An Expanded Sourcebook,
2nd edn. London: Sage.

Modigh, C., Axelsson, G., Alavanja, M., Andersson, L. and Rylander, R. (1996) Pet birds and
risk of lung cancer in Sweden: a case-control study. British Medical Journal, 313, 1236–1238.

369

References

Moseley, J.B., Jr., Wray, N.P., Kuykendall, D., Willis, K. and Landon, G. (1996) Arthroscopic
treatment of osteoarthritis of the knee: a prospective, randomized placebo-control trial.
American Journal of Sports Medicine, 24, 28–43.

Moseley, J.B., O’Malley, K., Petersen, N.J., Menke, T.J., Brody, B.A., Kuykendall, D.H.,
Hollingsworth, J.C., Ashton, C.M. and Wray, N.P. (2002) A controlled trial of arthroscopic
surgery for osteoarthritis of the knee. New England Journal of Medicine, 347 (2), 81–88.

Naerde, A. (2000) Symptoms of anxiety and depression among mothers of pre-school chil-
dren: effect of chronic strain related to children and child care-taking. Journal of Affective
Disorders, 58 (3), 181–199.

National Cancer Institute (2008) National Cancer Institute: U.S. National Institutes of
Health. Available at http://www.cancer.gov/, accessed 31 July 2009.

National Primary Care Research and Development Centre University of Manchester
(2007) Manual. General Practice Assessment Questionnaire (GPAQ) Version 2.1. For further
information on the GPAQ and also how to obtain a version for nurses, access the following
website http://www.gpaq.info/, accessed 15 August 2009.

NMC (2008) The Code. Standards of Conduct, Performance and Ethics for Nurses and Mid-
wives. London: Nursing and Midwifery Council.

(NRES) National Research Ethics Service (2007) Guidance for Applicants to the National
Research Ethics Service. London: NRES/National Patient Safety Agency.

(NRES) National Research Ethics Service (2008) Defining research. Issue 8. London:
NRES/National Patient Safety Agency.

Øvretveit, J. (1995) Team decision-making. Journal of Inter-Professional Care, 9, 41–51.

Papa, K.S. (2008) Symbolic Interactionism: Re-examining the Environment. Published
12 August 2008. Available online at http://community.advanceweb.com/blogs/ltc_5/
archive/2008/08/12/symbolic-interactionism-re-examining-the-environment.aspx, accessed
5 August 2009.

Petticrew, M. and Roberts, H. (2003) Evidence, hierarchies, and typologies: horses for
courses. Journal of Epidemiology and Community Health, 57, 527–529.

Pittet, D., Allegranzi, B., Sax, H., Chraiti, M.-N., Griffiths, W. and Richet, H. (2007) Double-blind,
randomized, crossover trial of three hand rub formulations: fast-track evaluation of tolera-
bility and acceptability. Infection Control and Hospital Epidemiology, 28 (12), 1344–1351.

Population Reference Bureau (2004) Country Profiles for Population and Reproductive
Health: Policy Developments and Indicators. Washington, DC: Population Reference Bureau.
Available at http://www.prb.org/.

Powell, H., Murray, G. and McKenzie, K. (2004) Staff perceptions of community learning
disability nurses’ role. Nursing Times, 100 (19), 40–42.

Quirk, A. and Lelliott, P. (2002) Acute wards: problems and solutions. A participant obser-
vation study of life on an acute psychiatric ward. Psychiatric Bulletin, 26, 344–345.

Reason, P. and Bradbury, H. (eds) (2007) Handbook of Action Research. London: Sage.

Ritchie, J. and Lewis, J. (2003) Qualitative Research Practice: A Guide for Social Science
Students and Researchers. London: Sage.

370

References

Rolfe, G. (1998) The theory–practice gap in nursing: from research-based practice to
practitioner-based research. Journal of Advanced Nursing, 28 (3), 672–679.

Rosendahl, E., Lundin-Olsson, L., Kallin, K., Jensen, J., Gustafson, Y. and Nyberg, L. (2003)
Prediction of falls among older people in residential care facilities by the Downton index.
Aging Clinical and Experimental Research, 15 (2), 142–147.

Rosenthal, R. (1991) Meta-analytic Procedures for Social Research, Rev. edn. Newbury Park,
CA: Sage.

Royal College of Nursing (2003) Developing Referral Criteria for District Nursing Services:
Guidance for Nurses. London: RCN.

Russell, C., Toussard, D. and Porter, M. (2002) What’s rapport got to do with it? The practi-
cal accomplishment of fieldwork in relations between young female researchers and so-
cially marginalised older men. The Qualitative Report, 7 (1), 1–18.

Schoolfield, M. and Orduña, A. (1994) Understanding staff nurse responses to change: uti-
lization of a grief-change framework to facilitate innovation. Clinical Nurse Specialist, 8,
57–62.

Scott, B.M. (2003) Situational Positioning: A Grounded Theory of Registered Nurse
Decision-making in Western Australian Nursing Homes. PhD thesis, Curtin University of
Technology, School of Nursing and Midwifery, Australia. Available at http://espace.library.
curtin.edu.au:80/R?func=dbin_jump_full&object_id=13781, accessed 5 August 2009.

Silverman, D. (1987) Communication and Medical Practice. London: Sage.

Silverman, D. (2007) A Very Short, Fairly Interesting and Reasonably Cheap Book about
Qualitative Research. London: Sage.

Skrabanek, P. and McCormick, J. (1994). Follies and Fallacies in Medicine, 4th edn. Whithorn:
Tarragon Press.

Smith, J.A. (1996) Beyond the divide between cognition and discourse: using interpreta-
tive phenomenological analysis in health psychology. Psychology and Health, 11, 261–271.

Smith, M. (2005) Does encouragement boost visual acuity testing results? Nursing Times,
101, 35, 38–41.

Stotts, R.C., Roberson, P. K., Hanna, E. Y., Jones, S. K. and Smith, C. K. (2003) A randomised
clinical trial of nicotine patches for treatment of spit tobacco addiction among adoles-
cents. Tobacco Control, 12(4), 11–15.

Strachan, D.P., Butland, B.K. and Anderson, H.R. (1996) Incidence and prognosis of asthma
and wheezing illness from early childhood to age 33 in a national British cohort. British
Medical Journal, 312, 1195–1199.

Strauss, A. and Corbin, J. (1998) Basics of Qualitative Research Techniques and Proce-
dures for Developing Grounded Theory, 2nd edn. London: Sage.

Tavakol, M., Torabi, S. and Zeinaloo, A.A. (2006) Grounded theory in medical education
research. Medical Education Online, 11 (30), 1-6. Available at http://www.med-ed-online.org/
volume11.htm, accessed 5 August 2009.

The Healthcare Commission (2007) Caring for Dignity: A National Report on Dignity in
Care for Older People while in Hospital. London: Healthcare Commission.

371

References

Thomas, P. (2006) General medical practitioners need to be aware of the theories on
which our work depend. Annals of Family Medicine, 4, 450–454.
Ung, Y.C., Maziak, D.E., Vanderveen, J.A. et al. (2007) 18Fluorodeoxyglucose positron emis-
sion tomography in the diagnosis and staging of lung cancer: a systematic review. Journal
of National Cancer Institute, 99, 1753–1767.

Vallenga, D., Grypdonck, M.H.F., Tan, F.I.Y., Lendemeijer B.H.G.M. and Boon, P.A.J.M. (2008)
Improving decision-making in caring for people with epilepsy and intellectual disability: an
action research project. Journal of Advanced Nursing, 61, 261–272.

Wakefield, A.J., Harvey, P. and Linnell, J. (2004) MMR—responding to retraction. The
Lancet, 363, (9417), 1327–1328.

Ward, E., King, M., Lloyd, M. et al. (2000) Randomised controlled trial of non-directive
counselling, cognitive-behaviour therapy, and usual general practitioner care for patients
with depression. I: Clinical effectiveness. British Medical Journal, 321, 1383–1388.

Ware, J.E., Snow, K.K., Kosinski, M. and Gandek, B. (1993) SF-36® Health Survey Manual
and Interpretation Guide. Boston, MA: New England Medical Center, The Health Institute.
Further information available from http://www.sf-36.org/tools/sf36.shtml#LIT, accessed
15 August 2009.

Watts, S., O’Hara, L. and Trigg, R. (in press) Living with Type 1 diabetes: a by-person quali-
tative exploration. Psychology and Health, DOI: 10.1080/08870440802688588

Williams, G.A. (2002) Cross-cultural and sex differences in job stress, somatisation, and
mental ill-health. In R. Roth and F. Farley (eds) The Spiritual Side of Psychology at
Century’s End. Lengerich: Pabst Publishers, pp. 269–279.

Williams, G.A. and Albery, I.P. (2003) Neuroticism Biases Work Stressor-Strain Links and
Should be Statistically Controlled. Poster presented at 5th Annual Conference of European
Academy of Occupational Health Psychology, Berlin, 20–21 November 2003.

Williams, G.A. and Laungani, P. (1999) Analysis of teamwork in an NHS Community Trust:
an empirical study. Journal of Inter-Professional Care, 13, 19–28.

Willig, C. (2001) Introducing Qualitative Research in Psychology. Adventures in Theory and
Method. Maidenhead: Open University Press.

Willis, B. and Wortley, P. (2007) Nurses; attitudes and beliefs about influenza and the in-
fluenza vaccine: a summary of focus groups in Alabama and Michigan. American Journal
of Infection Control, 35, 20–24.

World Medical Association (2000) Declaration of Helsinki Ethical Principles for Medical
Research Involving Human Subjects. Available at http://www.wma.net/e/ethicsunit/
helsinki.htm, accessed 4 August 2009.

Worrall, K. and Williams, G.A. (2004) Exploring the Relevance of ‘Flow’ in Explaining Paedi-
atric Nurses’ Satisfaction and Enjoyment at Work. Paper presented at the British Psycho-
logical Society Annual Conference, Imperial College, London, 15–17 April 2004.

Xu, Y. and Kwak, C. (2007) Comparative trend analysis of characteristics of foreign and
native nurses in the United States of America. International Nursing Review, 54, 78–84.

372

Index

Note: Boxes, Figures and Tables are indicated allocation of patients to treatments 339
by italic page numbers, and Glossary terms alternative hypothesis 25, 359
by emboldened numbers analysis 4, 16, 17
analytic hierarchy model 141–4
abstract conceptualisation [in action answerability of research question 325
research] 161, 162 antipsychotic medication, clinical trial

abstracts and summaries for 233–5
example 265 appropriateness of analyses 248, 249
in literature search 84–5, 90, 92 Aral, L. 319
in oral presentations 279 Arthur, A. 254, 302
in posters 287, 288, 289 association between variables 224–5
in written reports 262, 264–5 Atkinson, P. 140
attitudes and practices, surveys used 40
academic journal articles see journal audiovisual data 139
articles authors [in critical appraisal] 253, 254
autonomy 348
acceptability 246, 360 availability/convenience sampling 129
see also face validity average scores, comparing 228–36
averages 184–6
action planning 165, 166
action research 16, 17, 64–6, 155–74 types 184–5
see also mean; median; mode
change-related issues 165 Avicenna [physician] 27, 28
in education 161
evaluation phase 166 back pain survey 182–3
how not to do it 167–73 background literature, critical appraisal of
meaning of term 158–9, 359
philosophy of 159–61 253, 254
process 161–3 bar chart 186, 187, 359
spiral model 163, 164 BBC news health website 181, 213, 214
stages/phases 163–7 Beauchamp, T. 348
types 160 Beck Depression Inventory 246
action science 160 Becker, Howard 306
active experimentation [in action research] Beech, M. 328
behavioural observation research
161, 162
Addington-Hall, Julia 57 method 139
advanced thinking in research methods benchmarks 247, 248
beneficence 348–9
and practice 16, 18, 297–322 Bennett, J. 117
A&E admissions, questionnaires used bias 32, 101–2, 103

108–11 avoidance of 247, 248
aims of research, statement about 90, 93, bibliography 277
blood glucose monitoring [action research
97, 267
in critical appraisal 253, 254 example] 162
in research proposal 332
Albery, Ian P. 289
alcohol-based hand-cleansers 243, 321–2

373

Index

Blumer, Herbert 51, 52 randomisation of participants 105–6
bovine spongiform encephalopathy (BSE) single-blind trials 107, 363
types 29–32, 107
6–7, 178 see also randomised controlled trials
box plots 195–6 closed questions [in questionnaires and

examples 196, 197 surveys] 110–11
outliers in 197 coal miners, lung disease 8
Bradbury, H. 158 cognitive appraisal theory 317, 318
brainstorming 96–7 Cohen, Jacob 225, 226, 235
Breast Cancer Prevention Trial 30 cohort 359
breastfeeding, best evidence on 241–2 cohort study designs 23, 36–7, 41–2, 359
Brent Teaching Primary Care Trust 328
Brown, Janice 57 advantages 37
examples 38, 41–2
cardiovascular disease (CVD) 38 and longitudinal surveys 42–3
Carr, W. 163, 164 collaboration with others 305–9
case-control designs 23, 34–6, 359 collaborative inquiry 160
collaborators, identifying 330–1
advantages 36 collective truths 303
examples 34, 35–6 common method variance 250, 251
case study research method 63–4 Comte, Auguste 24, 25
Castonguay, G. 320–1 conceptual frameworks 140–1
categorical data/variables 180, 359 conclusions section [in poster], examples
categorical-type data/variables 181, 359
categories 137 287, 288, 289
causality/causation, and correlation 224, concrete experience [in action research]

250, 251 161, 162
change masters 165 confidentiality 124
charts 186–9 confounding variable 359
chi-square test 212, 214–18, 359 consent of research participants 124
construct validity 245–6, 359
in action 216–17 constructivism 54–5, 359
inadvisability of use 218
typical report of result 217 use in action research 64
writing up non-significant result 218 content analysis 145–6
Childress, J. 348 context to data collection 271
citation counts [for literature resources] continuous data/variables 180, 359
continuous-type data/variables 181, 359
86–8
Clabo, Laurie 62 suitability for parametric test 210, 211, 212
Clegg, F. 217 tests comparing same subjects on two
clinical assessment instruments 113–16
clinical audit 339 occasions 212, 232–5
clinical practice, applying research findings tests comparing two groups 212, 228–31
tests to examine relationship between
to 316–22
clinical trials 23, 27–32, 104–7, 359 212, 218–24
control group 360
control group in 105 convenience/availability sampling 129, 256
double-blind trials 107, 360 co-operative inquiry 160
guidelines 27–8 co-researchers, relationships among 307–8
intervention studies 28 correlation
observational studies 28
placebo effect 28, 104–5 and causation 224, 250, 251
effect size 225–7
374

Index

meaning of term 219, 220 data protection/security considerations
too many correlations 250, 251 124, 138
wrong kinds of data combinations
data triangulation 304
250, 251 Day, Liz 213
correlation statistics 212, 218–27 debriefing after study 125
deception of research participants 124–5
see also Pearson correlation; Spearman Declaration of Helsinki 348
correlation deductive approach 53
degrees of freedom 217
Coubrough, A. 68
Coué, Émile 104 examples in various tests 222, 231, 234
Cowan, J. 309 Delphi technique 308–9
Cox, J.L. 113, 115, 116 dementia study 126–8
credibility of studies 243 Denzin, N. 304
Criminal Records Bureau (CRB) screening dependent groups t-test 362
‘describe and decide’ approach
123–4
criterion validity 246, 360 to interpret inferential statistics 221–2,
critical appraisal 16, 17–18, 239–60 230, 233–4

meaning of term 240 to report inferential statistics 222, 230–1,
of qualitative studies 252–8 234–5
of quantitative studies 244–51
reasons for using 241–3 descriptive accounts, in qualitative analy-
‘critical path’ charts 336 sis 141, 143–4
cross-sectional surveys 23, 39–40, 360
examples 40 descriptive statistics 181–98
cultural change 157 examples 181–2
Cumulative Index to Nursing and meaning of term 176, 360
practice in performing 176–7
Allied Health Literature (CINAHL)
78, 80 Dheensa, Sandeep 119–20, 288
diagnostic trials 31, 360
Dartford and Gravesham NHS Trust 328 discourse analysis 136, 137–8
data discrete data/variables 180, 360
discussion section [in oral presentation]
types 138, 139
visual presentation of 186–9 279
data analysis in qualitative research example 281
discussion section [in poster], examples
144–52
critical appraisal of 253, 256–7 287, 288, 289
data analysis in quantitative research 16, discussion section [in research report]

17, 363 263–4, 275–6
descriptive statistics used 175–200 contextualising findings 275–6
Gantt chart for 337 critical appraisal of 257
data collection 16, 17 evaluation of study 276
in action research 165, 166 example 276–7
critical appraisal of 253, 256 interpretation of results 274, 275
details in reports 271 recommendation section 276
methods 100–29 dissemination of research results 262
data handling decisions, in qualitative in [sample] research proposal 335
distributions 188–9, 203–4
analysis 138–40, 152 district nurses, hospital staff’s view of
data management, in qualitative analysis
[case example] 324–6, 327–9
141, 142–3 Doll, Richard 34

375

Index

Donne, John 307 Folkman, Susan 317, 318
double-blind trial/study 107, 360 Foucaldian discourse analysis 137–8
Downton fall risk index 320 fourth-generation evaluation 65
dual moderator focus group 59 Framingham Heart Study 38
duelling moderator focus group 59 frequencies of data 182–4
frequency table 183, 361
ecological validity 245, 360
Edinburgh Postnatal Depression Scale 56, examples 183, 190, 191

113–16, 246 Gantt charts 336, 337–8
effect size 360 Garfinkel, Harold 50
‘gatekeepers’ [for research project] 308
in correlation statistics 225–7 General Practice Assessment Question-
small 227
for tests of difference 235–6 naire (GPAQ) 116
egalitarian approach to action genetic tests 30, 361
Gibbs, G. 162, 163, 310, 311
research 160 Glaser, Barney 53, 138
electronic databases 73, 75, 78, 80 Google Scholar search 69–70, 71
emancipatory research 160 Google search 68–9, 79
embarrassing questions 112 Gotzsche, P.C. 105
emergency departments, violence in 63–4 graphical representation of data/variables
empirical data 360
error 102–3 186–9
grounded theory 53–4, 138, 361
random or systematic 103 ‘groupthink’ [in focus groups] 58
ethical approval 125, 336, 339 Guba, I. 65
ethical considerations 336, 339–50
Hammersley, M. 140
and placebos 105 Harrington, A. 247
in qualitative research 123–5, 253, 255 health care resources, better use of 242–3
ethical dilemmas 307 health and clinical assessment instruments
ethnographic research 61–2, 360
building up rapport with participants 113–16
Helsinki Declaration 348
315–16 hierarchy of evidence 299, 300
ethnomethodology 50–1, 360 Hill, Austin Bradford 34
evaluation surveys 40 histogram 188, 361
evidence-based practice 18–19, 68, 360
expected frequencies 215, 360 examples 190, 191, 192
experiental learning theory 161–2, 309 Hobgood, Cherri 219
experiental truths 303 Hodgkins, Christopher 232
experimental designs 27–33 Holden, J.M. 113, 115
experimental methods 103–7 home care, synonyms/search terms
explanatory accounts, in qualitative
75, 77, 78
analysis 141, 144 hospital-acquired infection control
external validity 245, 360
practices 299, 301
face validity 246, 360 Hrobjartsson, A. 105
fairness 349 Huberman, A. 136, 140, 142
focus group research method 57–9, hypothesis/hypotheses 25–6, 361

121–3, 361 in literature 90–1, 92–3
example of use 59 hypothetical questions 112
thematic analysis in 146, 147 hypothetico-deductive approach 53

376

Index

imaging tests 30, 361 introductory section [of research report]
independent samples 361 262–3, 265–8
independent-samples t-test 202, 212, 213,
chronological order 267
228, 229–31 example 268
alternative names 229 general literature search and back-
interpreting 230
non-parametric alternative 231 ground 266
reporting results 230–1 specific literature search and back-
inductive approach 53
infection control in hospitals self- ground 266–7
themes approach 267
assessment exercise 321–2 investigator triangulation 304
inferential statistical tests 207–12 ISI Web of Knowledge Service for

choosing 212–13, 214 UK Education 80, 89
inferential statistics 16, 17, 201–37, 361 see also Web of Knowledge (WoK)
influenza immunisation among iterative group-related research 308–9

nurses 59 Jackson, Debra 63
informed consent 124, 348 Janis, I. 58
Integrated Research Application System Jefferson system [of recording dialogue]

(IRAS) 340 139n, 151–2
example 340–7 Johns Hopkins Medicine 328
intent in research 339 journal articles
interdependent researcher 329
inter-library loans 89 abstracts 84–5, 92
interpersonal relationships in nursing identifying variables within 7–11
searching 69–78
research 305–6 justice 349
interpretation of results [in research
Kelvin, Lord [William Thomson] 26
report] 274, 275 Kemmis, S. 163, 164
interpretative phenomenological analysis keywords, in literature search 73–8
Kipling, Rudyard 329
(IPA) 136, 146, 148–51, 361 knock-on effects 248, 249
clustering of themes 149–50, 151 Kolb, David 161–2, 309
identification of themes 149
interpretation 150–1 laboratory tests 30
researcher’s initial reactions 148–9 Laungani, P. 145, 273
summarising of themes 151, 151 Lazarus, Richard 317, 318
interrater reliability 246 leading questions [in questionnaires and
interval data/variables 180, 210, 361
intervention studies 28, 361 surveys] 111–12
interview research methods learning disability, and descriptive

56–7, 116–23 statistics 183–4, 187, 188
good practice 120–1 learning process, Kolb’s cyclical theory
see also focus group interviews; semi-
161–2, 309
structured interviews; structured Lewin, Kurt 159
interviews; unstructured interviews Lewis, J 141–2, 143, 144
introductory section [in oral library database
presentation] 279
example 280 searching 81–9
introductory section [in poster], examples ‘Title’ vs ‘Topic’ search 82–3
287, 288, 289 library resources 89
Lincoln, Y. 65

377

Index

literature review in study report 263, 266 method section [in oral presentation] 279
critical appraisal of 253, 254 example 281

literature search 4, 16, 17, 68–94, 326–9 method section [in poster], examples 287,
case example 327–9 288, 289
frequently cited resources 86–7
general resources and reviews 85–9 method section [in research report] 4, 91,
keywords used 73–8, 89 263, 268–71
library databases 81–5
reading articles 90–4 analysis section 272
recent resources 86 data collection details 271
reflections on resource 92 design section 269
search strategy 72–94 example 270
sources 78–80 materials/measures section 269
starting 68–71 procedure section 269
when to stop 88–9 for qualitative studies 271
for quantitative experimental/
logical rationalism 25
long-lasting effects 248, 249 intervention studies 269
longitudinal surveys 23, 39, 41–2, 361 for quantitative survey studies 269–70
sample details 269, 271
and cohort study designs 42–3 methodological triangulation 304
Luck, Lauretta 63–4 methodology 263
lung cancer, and smoking 34, 37 in literature search 91
lung disease 8 qualitative 16, 17, 48, 49–55, 91, 263, 363
quantitative 16, 17, 23, 24–7, 91, 363
McCormick, J. 107 Microsoft Excel software 336
McGarry, J. 62, 143, 146, 254, 257, 302, 324 Microsoft PowerPoint software 280–1, 282,
McKnight, M. 60–1
Maltby, John 213 294–6
Mann–Whitney U test 212, 228, 231, 361 Miles, M. 136, 140, 142
matched-groups t-test 232 mixed methods 91, 244, 302–3
matrix approach to compare research
Gantt chart for 338
methods 299, 301 mode 184, 185, 361
Mays, N. 302 moderator of focus group session 122
Mead, George Herbert 51 Moseley, Bruce 104–5
Mead, Margaret 59 motivation of researchers 257
mean 184, 185, 186, 361 MRSA ‘superbug’ study 214, 218
measles/mumps/rubella (MMR) vaccine, multi-collinearity 250, 251

best evidence on 241 narrative analysis 136
measurability of research question 325 narrative truths 303
measure of dispersion 194, 210 National Cancer Institute [USA], clinical

see also standard deviation trials 29, 30
measurement, meaning of term 26–7 National Census [UK] 39
measurement scales, too sensitive 250, 251 National Institute for Health and Clinical
median 185, 186, 361
medical subject headings (MeSH) 73–8 Excellence (NICE) 2
MedLine online resource 73, 75, 78 National Institutes of Health [USA], on
Meikle, James 6, 178
memory test results 126–8 clinical trials 29
meta-analyses 85, 299 National Nursing Home Survey [USA] 41
National Research Ethics Service
378
(NRES) 339
guidance leaflet 350

Index

needs assessment surveys 40 open questions [in questionnaires and
negative correlation 219, 220 surveys] 110
negatively skewed distribution 188, 189,
openness in approach to action 156
203, 362 oral presentation 277–86
neurofibromatosis (NF), study on coping
audience for 278
with 119–20, 146–51, 288 maintaining momentum 283
neuroticism, effect on work stressor–strain objectives 278
on-the-day issues 284–5
links 289 planning 279
newspaper articles, identifying variables PowerPoint used 281–2, 282
question-and-answer session 285
within 6–7, 177–9 rehearsal and preparation for 283–4
Nightingale, Florence 176, 186 simplification of 282–3
nominal data/variables 179–80 structure 279
non-malfeasance 349 ways to make/keep it interesting
non-parametric statistical tests 362
282–3
distinction from parametric tests 207–12 ordinal data/variables 180, 362
see also Mann–Whitney U test; Spearman organisational stakeholders 330
outliers 196–8
correlation test; Wilcoxon sign-ranks outsider’s perspective 305–6
test overview of this book 15–18
non-representative sampling 128–9
normal distribution 189, 203, 208, p-value 206, 363
209, 362 paired-samples t-test 212, 228, 362
null hypothesis 25–6, 362
Nurses’ Health studies 28 alternative names 232
nursing home surveys/studies 41–2, 52 interpreting 233–4
Nursing and Midwifery Council (NMC) non-parametric alternative 135
242, 307 reporting results 234–5
Nursing Times website 181 panel surveys 41–2
Papa, Kelly Smith 52
objective indicator variables 248–9 parametric statistical tests 207
objective truths 303 distinction from non-parametric tests
observational data 139
observational studies 28, 306, 362 207–12
observed frequencies 215, 362 see also independent-samples t-test;
older people, falls among, prediction
paired samples t-test; Pearson
of 320 correlation test
older people, falls among [fictional article] partial replication of study 246, 247
participant observation research method
key points [when reading] 92–4 59–61, 139
oral presentation [self-assessment participant welfare 123
participants in research
exercise] 291–6 consent 124
sections of report 265, 268, 270, 273, deception of 124–5
randomisation in clinical trials 105–6
276–7 rapport with 315–16
older people participatory action research 160
Pearson correlation coefficient 220, 221,
National Service Framework for 330 222, 362
quality of life [literature search]

68–92
synonyms/search terms 74–5, 76
one-tailed tests 223
ongoing consent 348

379

Index as poster 286–91
in research report 261–77
Pearson product-moment correlation test prevention trials 29–30, 363
212, 221–2 probability 204–5
probability value 206, 363
interpreting and reporting 221–2 professional code of conduct 307
non-parametric alternative 224 professional standards of competence, and
writing up non-significant result 223
percentiles 193, 362 critical appraisal 242
Pettigrew, M. 299, 300, 301 prompt cards for oral presentation 284
phase 1 trials 33, 362 protocol 363
phase 2 trials 33, 362 psychotherapy, positive thinking in 104
phase 3 trials 33, 362 PubMed online resource 73, 75, 78
phase 4 trials 33, 362 purposive sampling 256
phenomenology 50, 362
and positivism 50 qualitative analysis 16, 17, 133–54, 363
Piaget, Jean 54 aims 135–6
pictorial data 139 analytic hierarchy in 141–4
pie chart 186, 187, 362 methodological basis for 136
piloting of study methods 129 statement of research aims 267
Pittet, D. 321–2 transparency in 135–6, 151
placebo 28, 362 of uniqueness vs commonalities 137–8
ethics of use 105 value of competent analysis 137
placebo effect 104–5, 247
Pope, C. 302 qualitative data
population 126, 362 results section in research report 274
positive correlation 219, 220 ways of handling 139–40
positively skewed distribution 188, 189,
qualitative data analysis
203, 208, 362 in action 144–51
positivism 23, 24, 25 saturation in 152
stages 140–4
and phenomenology 50 steps to success 151–2
posters 286–91
qualitative methodology 16, 17, 48, 49–55,
creating 291 91, 363
design and presentation of 290–1
examples 287–9 qualitative/quantitative divide, bridging
general content 287–90 299–302
postmodernism 159
postnatal depression qualitative research 14, 15, 363
fathers [self-assessment exercise] blended with quantitative research
155–74
258–60 compared with quantitative research
South Asian compared with Caucasian 13–15, 252, 299–300, 302, 315
critical appraisal of study design 255
women 326–7 data types in 138, 139
Powell, H. 216 methods 48, 55–66, 271
power dynamics 137–8 report writing for 261–8, 271, 274–7
PowerPoint presentation 282 strengths and limitations 302

example 280–1 qualitative study
in self-assessment exercise 294–6 critical appraisal of 252–8
practice, and theory 157 method section in research
presentation of findings 4, 16, 18, 261–96 report 271
critical appraisal of 257
oral presentation 277–86

380

Index

poster [example] 288 factors affecting use 108
reflecting on 312–13 format of responses 113
quality of life health and clinical assessment
for older people [literature search]
instruments 113–16
68–94 leading questions 111–12
synonyms/search terms 74 types of questions to avoid 112–13
quality-of-life trials 32, 363 quota sampling 128–9
quantitative analysis 16, 17, 363
descriptive statistics used 175–200 random bias 103
statement of research aims 267 random error 103
quantitative correlational study, critical random sampling 128, 363
randomisation 105, 363
appraisal of 249–51
quantitative data, results section in research vs audit/evaluation 339
randomised controlled trials (RCTs) 23, 32,
research report 272–4
quantitative experimental/intervention 104–7, 363
limitations 299
study see also clinical trials
critical appraisal of 247–9 range, as measure of variability 191–2
method section in research rapport with participants 315–16
ratio data/variables 180, 210, 363
report 269 reading of literature, plan to approach
quantitative methodology 16, 17, 23, 24–7,
90–2, 95
91, 363 Reason, P. 158
quantitative research 14, 15, 244, 363 references section [in research

and bias 101–2 report] 277
blended with qualitative research 155–74 reflective cycle/framework 310, 311–12
compared with qualitative research
in action research 162, 163
13–15, 252, 299–300, 302, 315 reflective observation [in action research]
designs and methods 23, 27–43, 269
and error 102–3 161, 162
inferential statistics in 201–37 reflexivity 257, 309–16
report writing for 261–70, 272–4, 275–7 relationships between variables, tests for
strengths and limitations 302
quantitative study 214–24, 246
critical appraisal of 244–51 relevance of research question to clinical
method section in research report
practice 325–6, 335
269–70 reliability 246, 248, 249, 250
poster [example] 289 replication studies 247
reflecting on 314–15 report writing 261–77
quantitative survey study, method section
see also research report
in research report 269–70 representative sampling 128
quartiles 193, 363 research
quasi-experimental research designs 23,
ethical issues to consider 348–50
34–8, 363 meaning of term 2
question-and-answer session [after oral and theory 11–13
research-based evidence 18–19
presentation] 285 Research Ethics Committees (RECs)
questionnaires and surveys 107–16 applications to 340, 341–7, 349
approval sought from 336, 339
clarity of questions 111 research ideas 16, 17, 94, 96–7
closed vs open questions 110–11
designing 108–13 381

Index

research methods samples 126, 363
choosing 100–3 sampling 126–9
in [sample] research proposal 333–4
critical appraisal of 253, 255–6
research posters 286–91 details in reports 269, 271
see also posters non-representative 128–9
representative 128
research process 3–5 types 128–9, 256
cycle of activity 4–5 sampling error, impact on clinical care 126–8
reflecting on 310, 311 saturation, in qualitative analysis 152
stages 3–4 Scott, B.M. 53–4
Scott, Kirsty 7
research proposal screening trials 30, 363
developing 331–6 self-citation [of literature resources] 87
example 332–5 semi-interquartile range 192–4, 363
reviewing [self-assessment exercise] 350–2 semi-structured interviews 56, 118–19
example 119–20
research question 4, 16, 17 service evaluation 339
defining 324–6 service users 330
in literature 90–1, 92–3 SF-36 Health Survey 116
rationale for 250 Side Effects Scale/Checklist for Anti-

research report psychotic Medication (SESCAM) 117
abstract/summary section 262, 264–5 significance level, reporting in various
appendices 277
critical appraisal of 247–58 tests 222, 231, 234
discussion section 263–4, 275–6 significance testing 205–6
introductory section 262–3, 265–8
method section 263, 268–71 in chi-square test 215
references section 277 with one- and two-tailed hypotheses 223
results/findings section 263, 272–4 single-blind study/trial 107, 363
sections 262–4 situational positioning 53–4
skewness statistic 208, 209
results/findings section [in oral Skrabanek, P. 107
presentation] 279 SMART approach [to defining research

example 281 question] 324–6
results/findings section [in poster], Smith, Maureen 229
‘snowball’ sampling 129, 256
examples 287, 288, 289 social context of study 258
results/findings section [in research social desirability, questions that involve

report] 263, 272–4 112–13
example 273 Spearman correlation test 212, 224, 363
interpreting results 274 specificity of research question 325
Ritchie, J. 141–2, 143, 144 spit tobacco addiction 106
role conflicts [nurse vs researcher] 307 stakeholders
role of researcher, reflecting on 257–8,
identifying 329–30
310, 311 working in/with 308
Rolfe, G. 317 standard deviation 194–5, 363
Rosendahl, E. 320 statistical inference 204, 364
Rosenthal, Robert 227 statistical significance 206, 364
Royal College of Nursing (RCN) guidance 327 steering group [for research project] 308
Rumsfeld, Donald 156 Stotts, 106

Sagovsky, R. 113, 115
sample size 248, 256

382

Index

stratified sampling 128, 364 trend analysis 42
Strauss, A. 138 triangulation 303–5
stress
types 304
and neuroticism 289 trustworthiness 257
physical effects [study] 145–6 ‘truths’, as ways of seeing issues 300, 303
stress and coping, general model for 317–19 two-tailed tests 223
structured interviews 56, 116–18 two-way focus group 59
Student’s t-test see independent-samples Type I error 223, 364

t-test uncertainty in research 156, 164
subjective truths 303 unstructured interviews 56–7
survey research designs 23, 38–43, 364 Usher, Kim 63
surveys see questionnaires and surveys
symbolic interactionism 51–3, 364 validity 245, 248, 249, 250
synonyms, in literature search 72, 74 types 245–6
systematic bias 103
systematic error 103 Vallenga, Dineke 66
systematic reviews of data 299, 336, 339 variability 189–95

t-test for related measures see paired- visual presentation of 195–6
samples t-test see also range; semi-interquartile range;

t-test for unrelated measures see standard deviation
independent-samples t-test variables 5–11, 364

teenage pregnancies, reducing [self- in academic titles and text 7–11
assessment exercise] 319–20 describing 181–98
distinctions between types 179–81
test of independence see chi-square test distinctions within 179
test–retest reliability 246 exercises to identify 9–10
tests of difference 228–35 identifying 6–11
measuring 177–9
effect sizes for 235–6 openness in selection 248, 249
textual data 139 vCJD cases 6–7, 177–9
thematic analysis 146 venous thromboembolism, in pregnancy
themes 137
theory and childbirth 35–6
visuals, in oral presentation 282
and practice 157 vulnerable participants 123–4
and research 11–13
theory triangulation 304 waiting time study 185–6, 196
third variable 250, 251 Web of Knowledge (WoK) 80
Thom, N. 146
Thomas, Paul 300, 303 searching 81–9
time focus of research question 326 Wikipedia 79–80
timescale of research project 336 Wilcoxon sign-ranks test 212, 228, 235, 364
transferability 257 Williams, Glenn A. 119–20, 145, 146, 213,
in [sample] research proposal 335
transitions in oral presentation 283 273, 288, 289
transparency of study procedure 248, 249 Willis, B. 59
treatment trials 31, 364 withdrawal from research 125, 348
treatment/care techniques, assessment Wortley, P. 59
wound care, bandaging used for
of 339
[self-assessment exercise] 320–1

383